Healthcare Provider Details

I. General information

NPI: 1316388366
Provider Name (Legal Business Name): ELIZABETH FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2013
Last Update Date: 05/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CASTLE HILL AVE
BRONX NY
10473-1313
US

IV. Provider business mailing address

1 DAISY PL
BRONX NY
10465-3925
US

V. Phone/Fax

Practice location:
  • Phone: 718-794-3291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number634760
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number634760
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: