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NPI Code Detail

MEDICARE: ELISSA ROOP

MEDICARE: ELISSA ROOP
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
1363LF0000XFamily Nurse Practitioner209035042IL

General Provider Information

NPI Number : 1912850579
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISSA ROOP
Provider Business Mailing Address
First Line : 133 SPINDER DR
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-0016
Country : US
Telephone Number : 855-673-4325
Fax Number : 855-673-4325
Provider Business Practice Location Address
First Line : 133 SPINDER DR
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-0016
Country : US
Telephone Number : 855-673-4325
Fax Number : 855-673-4325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 03/20/2026

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Directions to “ ELISSA ROOP ” Practice Location

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