Provider Demographics
NPI:1174593107
Name:BORGER, ELIZABETH MYRA (ARNP CNM)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MYRA
Last Name:BORGER
Suffix:
Gender:F
Credentials:ARNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E LAFAYETTE ST
Mailing Address - Street 2:SUITE: 4
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4579
Mailing Address - Country:US
Mailing Address - Phone:850-583-2696
Mailing Address - Fax:850-792-6043
Practice Address - Street 1:1030 E LAFAYETTE ST
Practice Address - Street 2:SUITE: 4
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4579
Practice Address - Country:US
Practice Address - Phone:850-583-2696
Practice Address - Fax:850-792-6043
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2772732363LC1500X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034995000Medicaid