Provider Demographics
NPI:1538212147
Name:ELIZABETH JAN GILLESPIE CRNA
Entity type:Organization
Organization Name:ELIZABETH JAN GILLESPIE CRNA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:850-995-6193
Mailing Address - Street 1:3090 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8425
Mailing Address - Country:US
Mailing Address - Phone:850-995-6193
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-434-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9208292282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1300980 03Medicaid
FL430047793OtherRAIL ROAD
FL89932-COtherBLUE CROSS
FL89932-COtherBLUE CROSS