Provider Demographics
NPI:1295602860
Name:ELIZALDE, VIRIDIANA (RN)
Entity type:Individual
Prefix:
First Name:VIRIDIANA
Middle Name:
Last Name:ELIZALDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VIDDY
Other - Middle Name:
Other - Last Name:ELIZALDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2301 FEBRUARY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-3023
Mailing Address - Country:US
Mailing Address - Phone:214-606-2539
Mailing Address - Fax:
Practice Address - Street 1:2301 FEBRUARY LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-3023
Practice Address - Country:US
Practice Address - Phone:214-606-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054628163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse