Provider Demographics
NPI:1346080744
Name:SLOSBERG, ELISA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:
Last Name:SLOSBERG
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 1:14386 W CARLIN DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4230
Mailing Address - Country:US
Mailing Address - Phone:480-910-6081
Mailing Address - Fax:480-903-7445
Practice Address - Street 1:1626 BEECHER ST
Practice Address - Street 2:
Practice Address - City:CLARKDALE
Practice Address - State:AZ
Practice Address - Zip Code:86324-3021
Practice Address - Country:US
Practice Address - Phone:480-910-6081
Practice Address - Fax:480-903-7445
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ307422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ202246Medicaid