Provider Demographics
NPI:1578434890
Name:HUSO, ELYSSA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:ELYSSA
Middle Name:MARIE
Last Name:HUSO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELYSSA
Other - Middle Name:MARIE
Other - Last Name:MARGOLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14420 W MEEKER BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5287
Mailing Address - Country:US
Mailing Address - Phone:623-267-6700
Mailing Address - Fax:623-267-6701
Practice Address - Street 1:14420 W MEEKER BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5287
Practice Address - Country:US
Practice Address - Phone:623-267-6700
Practice Address - Fax:623-267-6701
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ217849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily