Provider Demographics
NPI:1720141112
Name:ROSS, ELIZABETH MARY (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:ROSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:HARKNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:22 PARK TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5334
Mailing Address - Country:US
Mailing Address - Phone:904-347-8470
Mailing Address - Fax:
Practice Address - Street 1:22 PARK TERRACE DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5334
Practice Address - Country:US
Practice Address - Phone:904-347-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO1279207V00000X
FL176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology