Individual
JEFFERY D ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1551 BISHOP ST, SUITE110/160, SAN LUIS OBISPO, CA 93401-4635
(805) 542-6729
(805) 269-1597
Mailing address
2050 S BLOSSER RD, SANTA MARIA, CA 93458-7310
(805) 361-8028
(805) 361-8097
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
12502
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12502
NP FURNISHING
CA
01
—
20005000564-34
ANCC APRN- BC (PSYCH)
CA
01
—
24836
REGISTERED NURSE
AK
01
—
384948
REGISTERED NURSE
CA
01
—
57311
PUBLIC HEALTH NURSE
CA
01
—
866
ADVANCED NP
AK
01
—
R0052489
REGISTERED NURSE
OK
Enumeration date
10/23/2006
Last updated
03/07/2023
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