Provider Demographics
NPI:1538120373
Name:ELIZALDE, MARIA TERESA (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:ELIZALDE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SAINT PAUL ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1334
Mailing Address - Country:US
Mailing Address - Phone:301-432-6897
Mailing Address - Fax:301-432-6298
Practice Address - Street 1:9 SAINT PAUL ST STE 3
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1334
Practice Address - Country:US
Practice Address - Phone:301-432-6897
Practice Address - Fax:301-432-6298
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR100650363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD544300800Medicaid
MD743L669DMedicare ID - Type Unspecified