Provider Demographics
NPI:1760204689
Name:ELIZALDE, VANESSA (APRN-CNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ELIZALDE
Suffix:
Gender:
Credentials:APRN-CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CONDOR DR
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-0190
Mailing Address - Country:US
Mailing Address - Phone:832-801-2348
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE 4387
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4639
Practice Address - Country:US
Practice Address - Phone:480-684-2595
Practice Address - Fax:602-887-3724
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179198363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health