Provider Demographics
NPI:1710228978
Name:GOLDBERG, ELYSE (ANP-C)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HOSPICE CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6372
Mailing Address - Country:US
Mailing Address - Phone:919-828-0890
Mailing Address - Fax:
Practice Address - Street 1:250 HOSPICE CIR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6372
Practice Address - Country:US
Practice Address - Phone:919-828-0890
Practice Address - Fax:919-350-7988
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC257372363LP2300X
NC5006095363LP2300X
SC5006095363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care