Individual
ELIZABETH EASTERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
555 STOCKTON ST, JACKSONVILLE, FL 32204-2534
(904) 387-4661
Mailing address
555 STOCKTON ST, JACKSONVILLE, FL 32204-2534
(904) 387-4661
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5235695
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PN5235695
—
FL
Enumeration date
05/11/2022
Last updated
05/11/2022
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