Individual
ELIZABETH A.S. DIERSING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
655 W 8TH ST, UFJAX - SURGERY DEPT, JACKSONVILLE, FL 32209-6511
(904) 244-3416
(904) 244-4687
Mailing address
PO BOX 44008, UFJP - PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3199
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9104503
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293020-00
—
FL
05
—
566221488A
—
GA
05
—
566221488B
—
GA
Enumeration date
02/15/2008
Last updated
03/17/2017
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