Provider Demographics
NPI:1447056858
Name:ELIZONDO, LAURA L (APRN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:ELIZONDO
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 OSCEOLA DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-3052
Mailing Address - Country:US
Mailing Address - Phone:817-905-6966
Mailing Address - Fax:
Practice Address - Street 1:131 OSCEOLA DR
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-3052
Practice Address - Country:US
Practice Address - Phone:817-905-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191554363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care