MEDICARE: ELIZANDA SALT SERRANO

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	363LF0000X	Family Nurse Practitioner	11030073	FL

General Provider Information

NPI Number	:	1679343511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZANDA SALT SERRANO

Provider Business Mailing Address
First Line	:	1883 W ROYAL HUNTE DR STE 200A
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-4000
Country	:	US
Telephone Number	:	561-336-0305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1883 W ROYAL HUNTE DR STE 200A
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-4000
Country	:	US
Telephone Number	:	561-336-0305
Fax Number	:

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

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	02/01/2026

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Directions to “ ELIZANDA SALT SERRANO ” Practice Location

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