MEDICARE: ELAINE AMBROSIO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	5014545	NC
2	363LA2200X	Adult Health Nurse Practitioner	5014545	NC
3	363LP2300X	Primary Care Nurse Practitioner	5014545	NC

General Provider Information

NPI Number	:	1124784533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE AMBROSIO NP

Provider Business Mailing Address
First Line	:	PO BOX 744786
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4786
Country	:	US
Telephone Number	:	704-834-2450
Fax Number	:	704-671-5331

Provider Business Practice Location Address
First Line	:	660 SUMMIT CROSSING PL
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2104
Country	:	US
Telephone Number	:	980-355-3774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2021
Last Update Date	:	12/19/2025

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