Healthcare Provider Details

I. General information

NPI: 1164845152
Provider Name (Legal Business Name): ELIZABETH JARRIN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH PUGA

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N RANDALL RD STE 210
ELGIN IL
60123-7879
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 224-760-7322
  • Fax: 224-525-8252
Mailing address:
  • Phone: 414-858-4106
  • Fax: 414-423-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209010879
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: