Provider Demographics
NPI:1225320138
Name:VELASQUEZ, ELIZABETH DIANE (MSN, AGPCNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MSN, AGPCNP
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:DIANE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, AGPCNP
Mailing Address - Street 1:7100 WESTWIND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1743
Mailing Address - Country:US
Mailing Address - Phone:915-474-7167
Mailing Address - Fax:855-888-3172
Practice Address - Street 1:7100 WESTWIND DR STE 300
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1743
Practice Address - Country:US
Practice Address - Phone:915-974-2200
Practice Address - Fax:855-888-3172
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731571163WC0200X
TX33887363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Multi-Specialty