Provider Demographics
NPI:1285207654
Name:CHAO, ELISHA (MSN, APRN, ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:CHAO
Suffix:
Gender:F
Credentials:MSN, APRN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181254
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78718-1254
Mailing Address - Country:US
Mailing Address - Phone:856-264-6426
Mailing Address - Fax:
Practice Address - Street 1:606 W CRESTLAND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1307
Practice Address - Country:US
Practice Address - Phone:856-264-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048140363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care