Provider Demographics
NPI:1720824568
Name:FEATHERSTONE, ELIZABETH EVANGELINE (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EVANGELINE
Last Name:FEATHERSTONE
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 AMHURST LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-7002
Mailing Address - Country:US
Mailing Address - Phone:727-687-3650
Mailing Address - Fax:
Practice Address - Street 1:7050 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5931
Practice Address - Country:US
Practice Address - Phone:727-392-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033784363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics