Individual
MRS. ELISABETH ANN PROENZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
210 MOSE COLEMAN DR, VIDALIA, GA 30474-8677
(912) 308-6484
Mailing address
210 MOSE COLEMAN DR, VIDALIA, GA 30474-8677
(912) 537-2200
(912) 537-2260
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN156767
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN156767
ADVANCED PRACTICE -NP NUMBER
GA
Enumeration date
05/31/2020
Last updated
12/08/2021
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