Provider Demographics
NPI:1073155594
Name:BORHA, ELYSE S (BSN, MSN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:S
Last Name:BORHA
Suffix:
Gender:F
Credentials:BSN, MSN, FNP-BC
Other - Prefix:MRS
Other - First Name:ELYSE
Other - Middle Name:S
Other - Last Name:BORHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, MSN, FNP-BC
Mailing Address - Street 1:12836 S NEW ROWLEY LN
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1430
Mailing Address - Country:US
Mailing Address - Phone:347-613-3493
Mailing Address - Fax:
Practice Address - Street 1:12836 S NEW ROWLEY LN
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-1430
Practice Address - Country:US
Practice Address - Phone:347-613-3493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9015163-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily