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Individual
TERESA ELIZABETH ELLIOTT
Active
Individual
TERESA ELIZABETH ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
0010-11395
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-11395
MEDICAL LICENSE
NC
Enumeration date
05/02/2012
Last updated
08/06/2021
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