MEDICARE: ELIZA CARSTON

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	163W00000X	Registered Nurse	1032544	TX

General Provider Information

NPI Number	:	1659191112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZA CARSTON

Provider Business Mailing Address
First Line	:	5020 MANOR RD APT 148
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-5305
Country	:	US
Telephone Number	:	757-777-8075
Fax Number	:

Provider Business Practice Location Address
First Line	:	4334 N LOOP 1604 W STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3485
Country	:	US
Telephone Number	:	210-918-8737
Fax Number	:

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

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	10/10/2024

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Directions to “ ELIZA CARSTON ” Practice Location

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