Healthcare Provider Details

I. General information

NPI: 1548511629
Provider Name (Legal Business Name): ELIZABETH A DEGUZMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH & CIVIC CENTER BLVD. STE 110
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

34TH AND CIVIC CENTER BLVD.
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-630-7973
  • Fax:
Mailing address:
  • Phone: 215-630-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberSP012142
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: