Provider Demographics
NPI:1174093504
Name:MARISKI, ELAINE NADAL (FNP-C)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:NADAL
Last Name:MARISKI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:ALCAZAR
Other - Last Name:NADAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4777 JUTLAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2554
Mailing Address - Country:US
Mailing Address - Phone:713-252-4584
Mailing Address - Fax:
Practice Address - Street 1:4401 MANCHESTER AVE STE 106
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4938
Practice Address - Country:US
Practice Address - Phone:760-753-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty