Provider Demographics
NPI:1811223951
Name:MARUCA, ELAINE (DNP, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:MARUCA
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2009
Mailing Address - Country:US
Mailing Address - Phone:267-341-3262
Mailing Address - Fax:
Practice Address - Street 1:9801 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2009
Practice Address - Country:US
Practice Address - Phone:267-341-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-25
Last Update Date:2019-09-24
Deactivation Date:2011-02-01
Deactivation Code:
Reactivation Date:2019-08-13
Provider Licenses
StateLicense IDTaxonomies
PAVP004673B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily