Healthcare Provider Details

I. General information

NPI: 1588384515
Provider Name (Legal Business Name): ELIZABETH PINCUS APRN, ACNS-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BUCKINGHAM DR APT 302
SANTA CLARA CA
95051-7111
US

IV. Provider business mailing address

30 BUCKINGHAM DR APT 302
SANTA CLARA CA
95051-7111
US

V. Phone/Fax

Practice location:
  • Phone: 917-549-0793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9514946
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNS4987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: