Ava Nicole Elisano

Key facts

NPI

1497621031

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

J3-0011003 (DE)

Practice address

210 S College Ave
Newark, DE 19716-5200

Phone

(302) 831-2792

NPI assigned

Oct 13, 2025

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 8, 2026.

{
    "created_epoch": "1760313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786147200000",
    "number": "1497621031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 GRAVEL HOLE RD",
            "city": "CAPE MAY COURT HOUSE",
            "state": "NJ",
            "postal_code": "082101307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S COLLEGE AVE",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197165200",
            "telephone_number": "302-831-2792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELISANO",
        "first_name": "AVA",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-13",
        "last_updated": "2026-08-08",
        "certification_date": "2026-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "DE",
            "license": "J3-0011003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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