Provider Demographics
NPI:1952566168
Name:ELZY, JACQUELINE A
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:ELZY
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 1:1375 SALTILLO ST.
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051
Mailing Address - Country:US
Mailing Address - Phone:214-715-4300
Mailing Address - Fax:
Practice Address - Street 1:1375 SALTILLO ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4460
Practice Address - Country:US
Practice Address - Phone:214-715-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider