Healthcare Provider Details

I. General information

NPI: 1386097525
Provider Name (Legal Business Name): ELIZABETH GUZZO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 01/26/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PORT WASHINGTON BOULEVARD
ROSLYN NY
11576
US

IV. Provider business mailing address

22 THOMPSON PLACE APT 3
LYNBROOK NY
11563
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-6000
  • Fax:
Mailing address:
  • Phone: 516-965-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340532
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number129314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: