Provider Demographics
NPI:1326573890
Name:GARCIA, ELISA GUADALUPE (FNP)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:GUADALUPE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:CA
Mailing Address - Zip Code:95987-0884
Mailing Address - Country:US
Mailing Address - Phone:254-245-4637
Mailing Address - Fax:
Practice Address - Street 1:3720 HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-4027
Practice Address - Country:US
Practice Address - Phone:530-458-0295
Practice Address - Fax:530-458-0390
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95104579163WS0200X
CA5533612083P0901X
CA95021815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine