Provider Demographics
NPI:1417712142
Name:ELARIO, TINA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ELARIO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 PLAZA LN # 128
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3204
Mailing Address - Country:US
Mailing Address - Phone:650-515-9391
Mailing Address - Fax:
Practice Address - Street 1:1362 RIDGEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030
Practice Address - Country:US
Practice Address - Phone:605-515-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA731847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse