Provider Demographics
NPI:1255747184
Name:ELMA, ELMER JONES TADENA (ACNP, PMHNP, ACNS)
Entity type:Individual
Prefix:
First Name:ELMER JONES
Middle Name:TADENA
Last Name:ELMA
Suffix:
Gender:M
Credentials:ACNP, PMHNP, ACNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1064
Mailing Address - Country:US
Mailing Address - Phone:518-770-7518
Mailing Address - Fax:518-770-7570
Practice Address - Street 1:427 GUY PARK AVE FL 3
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1064
Practice Address - Country:US
Practice Address - Phone:518-770-7518
Practice Address - Fax:518-770-7570
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430819363LA2100X
NY401862363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care