Basic Information
| Provider Information | |||||||||
| NPI: | 1689128555 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANCHOLA | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2686 W ALTON GLOOR BLVD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785204055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563505444 | ||||||||
| FaxNumber: | 9563502493 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 E PRICE RD BLDG F | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785213531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565046080 | ||||||||
| FaxNumber: | 9565046419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2016 | ||||||||
| LastUpdateDate: | 01/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP131644 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.