Provider Demographics
NPI:1659191112
Name:CARSTON, ELIZA
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:CARSTON
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 1:5020 MANOR RD APT 148
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-5305
Mailing Address - Country:US
Mailing Address - Phone:757-777-8075
Mailing Address - Fax:
Practice Address - Street 1:4334 N LOOP 1604 W STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3485
Practice Address - Country:US
Practice Address - Phone:210-918-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032544163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse