Healthcare Provider Details

I. General information

NPI: 1922429976
Provider Name (Legal Business Name): ELIZABETH JANE TINGUELY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1474 RODEO RD
SANTA FE NM
87505-6142
US

IV. Provider business mailing address

1056 CALLE GRIEGA
LAS CRUCES NM
88011-4228
US

V. Phone/Fax

Practice location:
  • Phone: 505-487-3888
  • Fax:
Mailing address:
  • Phone: 505-487-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR26234
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: