Provider Demographics
NPI:1023037710
Name:ELLIOTT, AUDREY CORSBERG (PMHNP)
Entity Type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:CORSBERG
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ELIZABETH
Other - Last Name:CORSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:202 E EARLL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2647
Mailing Address - Country:US
Mailing Address - Phone:602-808-2800
Mailing Address - Fax:
Practice Address - Street 1:4451 E OAK ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-2410
Practice Address - Country:US
Practice Address - Phone:602-957-2220
Practice Address - Fax:602-508-4492
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2233363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ123842Medicaid
AZ123842Medicaid