Provider Demographics
NPI:1720504152
Name:PETCOV, ELIZABETH A (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:PETCOV
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-4051
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:252 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6111
Practice Address - Country:US
Practice Address - Phone:717-270-4876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017652208M00000X, 363L00000X
PAMC4527581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily