Provider Demographics
NPI:1659574390
Name:MCELMELL, ELIZABETH ANN (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MCELMELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:MCELMELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1561 EDEN CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4209
Mailing Address - Country:US
Mailing Address - Phone:760-798-9880
Mailing Address - Fax:619-516-7335
Practice Address - Street 1:400 CRAVEN RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4201
Practice Address - Country:US
Practice Address - Phone:760-510-4066
Practice Address - Fax:619-516-7335
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant