Provider Demographics
NPI:1497202915
Name:MACHKOVSKY, ELVIRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:MACHKOVSKY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SIERRA ROAD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:94518
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7920 BELT LINE RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8148
Practice Address - Country:US
Practice Address - Phone:415-710-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003865363LF0000X
TXAP142985363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95003865OtherFAMILY NURSE PRACTITIONER CERTIFICATE
CA666426OtherRN CERTIFICATE