Provider Demographics
NPI:1184212805
Name:ESPARZA, ELISHA M
Entity Type:Individual
Prefix:MISS
First Name:ELISHA
Middle Name:M
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4330
Mailing Address - Country:US
Mailing Address - Phone:520-634-7578
Mailing Address - Fax:
Practice Address - Street 1:1346 N HEATH AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2206
Practice Address - Country:US
Practice Address - Phone:208-585-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ254819363LN0005X
ID4883163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical CareGroup - Single Specialty