Provider Demographics
NPI:1720292667
Name:LACSAMANA, ELIZABETH NATALIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NATALIE
Last Name:LACSAMANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:NATALIE
Other - Last Name:DE LA PAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1331 AARON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1032
Mailing Address - Country:US
Mailing Address - Phone:732-348-8022
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD PLACE
Practice Address - Street 2:SPECIAL PROCEDURES
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-828-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430287363LA2100X
NJ26NJ00825100363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care