Most Relevant Information
Provider Data
| NPI Number: | 1003650888 |
| Provider Name: | ELISSA SY AG-ACNP, APRN-CNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | 218715 |
Most Important Dates
| Enumeration Date: | 06/25/2024 |
| Last Updated: | 06/25/2024 |
Provider Practice Location
1120 S UTICA AVE
TULSA
OK
741044090
Practice Location Phone/Fax
| Phone: | 9185791000 |
| Fax: |
Provider Mailing Location
14429 S HUDSON AVE
BIXBY
OK
740084074
Provider Mailing Phone/Fax
| Phone: | 9186951278 |
| Fax: |