Provider Demographics
NPI:1215217906
Name:CROSS, ELIZABETH MARTIN (RN, PNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARTIN
Last Name:CROSS
Suffix:
Gender:F
Credentials:RN, PNP-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARTIN CROSS
Other - Last Name:JAKESCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7940 SHOAL CREEK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7589
Mailing Address - Country:US
Mailing Address - Phone:512-494-4000
Mailing Address - Fax:512-494-4024
Practice Address - Street 1:7940 SHOAL CREEK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7589
Practice Address - Country:US
Practice Address - Phone:512-494-4000
Practice Address - Fax:512-494-4024
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1200432084N0402X
TXAP120043363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology