MEDICARE: ELIZABETH SUZANNE PRYBYLA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95209246	CA

General Provider Information

NPI Number	:	1447074695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SUZANNE PRYBYLA NP

Provider Business Mailing Address
First Line	:	40 HERMOSA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-6107
Country	:	US
Telephone Number	:	718-809-8964
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 HERMOSA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-6107
Country	:	US
Telephone Number	:	718-809-8964
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	11/12/2025

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