Provider Demographics
NPI:1689128555
Name:CANCHOLA, ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CANCHOLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2686 W ALTON GLOOR BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-4055
Mailing Address - Country:US
Mailing Address - Phone:956-350-5444
Mailing Address - Fax:956-350-2493
Practice Address - Street 1:95 E PRICE RD BLDG F
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3531
Practice Address - Country:US
Practice Address - Phone:956-504-6080
Practice Address - Fax:956-504-6419
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily