Healthcare Provider Details

I. General information

NPI: 1073083093
Provider Name (Legal Business Name): ELIZABETH HUFFAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH SANS NP

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PL
BRONX NY
10461-2720
US

IV. Provider business mailing address

1250 WATERS PL
BRONX NY
10461-2720
US

V. Phone/Fax

Practice location:
  • Phone: 646-670-5130
  • Fax: 929-263-3948
Mailing address:
  • Phone: 646-670-5130
  • Fax: 929-263-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342995-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: