Provider Demographics
NPI:1700398898
Name:FOSTINO, ELISABETH JANE (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:JANE
Last Name:FOSTINO
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15136 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6909
Mailing Address - Country:US
Mailing Address - Phone:217-853-7452
Mailing Address - Fax:
Practice Address - Street 1:15640 N 28TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4059
Practice Address - Country:US
Practice Address - Phone:217-439-9000
Practice Address - Fax:602-978-5233
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-29
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ259849363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty