Provider Demographics
NPI:1619528833
Name:PAK, ELIZABETH (CRNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 COMMERCE DR # 220
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2600
Mailing Address - Country:US
Mailing Address - Phone:267-715-2089
Mailing Address - Fax:267-361-1300
Practice Address - Street 1:390 COMMERCE DR # 220
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2600
Practice Address - Country:US
Practice Address - Phone:267-715-2089
Practice Address - Fax:267-361-1300
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2025-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020867363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health