Provider Demographics
NPI:1851156236
Name:WAZ, ELAINE SMITH (FNP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:SMITH
Last Name:WAZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:CROWELL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:209 BURROUGHS AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5307
Mailing Address - Country:US
Mailing Address - Phone:843-670-4265
Mailing Address - Fax:
Practice Address - Street 1:14 OAK FOREST RD STE D
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4988
Practice Address - Country:US
Practice Address - Phone:912-214-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily