Provider Demographics
NPI:1497156566
Name:ZAMORA, ELAINE LORETTA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:LORETTA
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:LORETTA
Other - Last Name:ZAMORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1104 CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2601
Mailing Address - Country:US
Mailing Address - Phone:210-365-7681
Mailing Address - Fax:
Practice Address - Street 1:475 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4403
Practice Address - Country:US
Practice Address - Phone:866-910-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125998363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391702YMSZMedicare PIN