Healthcare Provider Details

I. General information

NPI: 1124784533
Provider Name (Legal Business Name): ELAINE AMBROSIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELAINE CAROLEO

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SUMMIT CROSSING PL
GASTONIA NC
28054-2104
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 980-355-3774
  • Fax:
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5014545
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5014545
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5014545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: