Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209017960 | IL |
NPI | 1003308347 |
---|---|
Provider Name | Elizabeth Ann Floyd |
First Address | Bloomington, IL 61705-7509 |
Second Address | Rantoul, IL 61866-2166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2018 |
Last Update Date | 02/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F05180615 | AANP CERTIFICATION NUMBER (01) |