Elizabeth Forman Serdar, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP 60301000 Issued in WA

Practice address

200 Lilly Rd NE Ste C
Olympia, WA 98506-5080

Phone

(360) 918-8336

Fax

(360) 972-2152

NPI assigned

Aug 13, 2012

Last updated

Dec 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heritage Family MedicineGroup PAC ID 8628084712, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Heritage Family Medicine

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1427136977
  Medicare reassignment Care Compare group
• Easy Health Medical Solutions PC

  • Nurse Practitioner
  • Fulton, MD
  • NPI 1972179141

  WA

  Medicare reassignment NPD
• Northwest Resources II

  • Addiction (Substance Use Disorder) Counselor
  • Olympia, WA
  • NPI 1164586210
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1629325204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 LILLY RD NE STE C",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065080",
            "telephone_number": "360-481-7788",
            "fax_number": "360-972-2152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 LILLY RD NE STE C",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065080",
            "telephone_number": "360-918-8336",
            "fax_number": "360-972-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN SERDAR",
        "first_name": "ELIZABETH",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60301000",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP 60301000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2025519",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I WA",
            "identifier": "304788",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Princewill Fonta, PMHNP
• Larry L Fontanilla Jr., MD
• Ahmad Fora, MD
• Forest Shores Capital (Joshua Grant, PA-C)
• Imanie Marie Forest, RN
• Celia G Forno, PMHNP
• Ian Ferguson Forster
• Samantha Rosa Forster
• Ashley Nicole Forsythe
• Shaleeni Fortner, RN

• Family Nurse Practitioner in Olympia, WA
• Providers in Olympia, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.