Healthcare Provider Details

I. General information

NPI: 1265787170
Provider Name (Legal Business Name): ELIZABETH SCOTT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY SOUTH SUITE 100A
HALF MOON BAY CA
94019
US

IV. Provider business mailing address

225 CABRILLO HWY SOUTH SUITE 100A
HALF MOON BAY CA
94019
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-2229
  • Fax:
Mailing address:
  • Phone: 860-347-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005077
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number99543
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: