Healthcare Provider Details

I. General information

NPI: 1780186148
Provider Name (Legal Business Name): ELIZABETH VACCARO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N RANDALL RD STE 2-1200
ELGIN IL
60123-2300
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1298
US

V. Phone/Fax

Practice location:
  • Phone: 312-609-0300
  • Fax: 224-783-2527
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017066
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: