Provider Demographics
NPI:1295123867
Name:TRISOTTO, ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:TRISOTTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 PRAIRIE DUNES CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2680
Mailing Address - Country:US
Mailing Address - Phone:407-923-6033
Mailing Address - Fax:
Practice Address - Street 1:1400 BROADFIELD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5162
Practice Address - Country:US
Practice Address - Phone:914-919-9200
Practice Address - Fax:833-913-2393
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9247996363L00000X
FL9247996363LF0000X
FLARNP9247996363LF0000X
TN37822363L00000X
MI4704422867363L00000X
NJ26NJ15254300363L00000X
MO2025011721363L00000X
NVPR18031363L00000X
LA239281363L00000X
NV884939363L00000X
GAGAA-NP003021363L00000X
MS907426363L00000X
NE115798363L00000X
KY4033233363L00000X
TX1170315363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily