Provider Demographics
NPI:1508222852
Name:WHITAKER, ELIZABETH LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LYNN
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7720 US HIGHWAY 98 W STE 310
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7232
Practice Address - Country:US
Practice Address - Phone:850-267-2961
Practice Address - Fax:850-278-3780
Is Sole Proprietor?:No
Enumeration Date:2016-01-01
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006316363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology