Provider Demographics
NPI:1356330351
Name:NARDACCI, ELIZABETH ANNE (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:NARDACCI
Suffix:
Gender:F
Credentials:NP
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 14890
Mailing Address - Street 2:SPHP PAYER CREDENTIALING
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212
Mailing Address - Country:US
Mailing Address - Phone:518-591-1121
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:63 SHAKER ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204
Practice Address - Country:US
Practice Address - Phone:518-471-3636
Practice Address - Fax:518-471-3668
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331792-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01927417Medicaid
NY01927417Medicaid
NYBB2707Medicare ID - Type Unspecified