Provider Demographics
NPI:1356760011
Name:ELLIOTT, CHARISSA SALLIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CHARISSA
Middle Name:SALLIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1667
Mailing Address - Country:US
Mailing Address - Phone:319-768-5858
Mailing Address - Fax:319-752-4653
Practice Address - Street 1:1706 W AGENCY RD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1667
Practice Address - Country:US
Practice Address - Phone:319-768-5858
Practice Address - Fax:319-752-4653
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA087662363LF0000X
AZRN144548163W00000X, 163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0000XNursing Service ProvidersRegistered NursePain Management