Provider Demographics
NPI:1336111061
Name:ELLIOTT, TERRI L (PAC)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 SIERRA ROSE DR STE B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2076
Mailing Address - Country:US
Mailing Address - Phone:775-323-3000
Mailing Address - Fax:775-323-3001
Practice Address - Street 1:689 SIERRA ROSE DR STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2076
Practice Address - Country:US
Practice Address - Phone:775-323-3000
Practice Address - Fax:775-323-3001
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA923363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506909Medicaid
NV100506909Medicaid
NVV101294Medicare PIN
NVP00293624Medicare PIN