Provider Demographics
NPI:1023171725
Name:PACARRO, ELIZABETH JOYCE (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOYCE
Last Name:PACARRO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:JOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:17055 RUBEN LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-9276
Mailing Address - Country:US
Mailing Address - Phone:503-668-8002
Mailing Address - Fax:
Practice Address - Street 1:17055 RUBEN LN
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-9276
Practice Address - Country:US
Practice Address - Phone:503-668-8002
Practice Address - Fax:503-668-5246
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-466363L00000X
OR10020280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000254029OtherHMSA
HI523979-01Medicaid
HIH55034Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
HI523979-01Medicaid