Provider Demographics
NPI:1497095103
Name:TADINA, ELIZABETH CHUA (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:CHUA
Last Name:TADINA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3758 LAS VEGAS BLVD S
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-4132
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:401-216-3854
Practice Address - Street 1:3758 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-216-3854
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60568533363L00000X
TX823528363LF0000X
NVAPRN002826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047519Medicaid
WA2047519Medicaid