Provider Demographics
NPI:1821566233
Name:ELIZONDO, CHARLOTTE STILES (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:STILES
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:ANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12218 VALLEY LODGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3666
Mailing Address - Country:US
Mailing Address - Phone:281-898-0486
Mailing Address - Fax:
Practice Address - Street 1:22999 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4412
Practice Address - Country:US
Practice Address - Phone:281-348-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28376OtherRX AUTHORITY NUMBER
TXA139603OtherAPRN LISCENSE