Individual provider Active NPI

Elisha E Christianson, FNP

  • Family Nurse Practitioner
  • Waterbury, CT
National Provider Identifier
1609124528
Registry record updated Feb 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5899 Issued in CT
Practice address
1078 W Main St
Waterbury, CT 06708-2651
Phone
(203) 757-1585
Fax
(203) 757-0300
NPI assigned
Aug 27, 2012
Last updated
Feb 9, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5899 CT Primary

Addresses

Primary practice location

1078 W Main St
Waterbury, CT 06708-2651

Mailing address

4700 Exchange CT Ste 110
Boca Raton, FL 33431-4450
Phone (561) 948-0291

Other practice location 1

1343 Boston Post Rd Apt 101
Madison, CT 06443-3481
Phone (860) 669-6156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201015002966 CT Practitioner - Nurse Practitioner 8123448990 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Dermatology of Waterbury LLCGroup PAC ID 9133467665, 4 clinicians
Integrated Dermatology of Clinton LLCGroup PAC ID 7416257381, 8 clinicians

Practice addresses (Care Compare)

1078 W Main St
Waterbury, CT 06708-2651
Phone (203) 757-1585

1343 Boston Post Rd
Apt 101
Madison, CT 06443-3481
Phone (860) 259-4037

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
98.94 of 100Reported as group
Quality
96.67
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5899CTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Dermatology of Clinton, LLC CurrentSince Aug 20, 2020 Accepting new patients
Integrated Dermatology of Waterbury, LLC CurrentSince Oct 1, 2020 Accepting new patients
On Site Dermatology of Connecticut LLC PastSince Mar 31, 2024 Accepting new patients
Southern Connecticut Dermatology, P.C. Past Accepting new patients

Locations

4639 Main St
Bridgeport, CT 06606
Phone (203) 374-5546

8 E Main St
Ste 101
Clinton, CT 06413
Phone (860) 669-6156

2 Pomperaug Office Park
Southbury, CT 06488
Phone (203) 264-1735

493 Heritage Rd
Ste 1C
Southbury, CT 06488
Phone (203) 586-1385

1078 W Main St
Waterbury, CT 06708
Phone (203) 753-8336

4700 Exchange Ct
Ste 110
Boca Raton, FL 33431
Phone (561) 223-8081

902 Clint Moore Rd
Ste 226
Boca Raton, FL 33487

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770595200000",
    "number": "1609124528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-948-0291",
            "fax_number": "561-859-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1078 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082651",
            "telephone_number": "203-757-1585",
            "fax_number": "203-757-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1343 Boston Post Rd Apt 101",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "CT",
            "postal_code": "064433481",
            "country_code": "US",
            "telephone_number": "860-669-6156",
            "fax_number": "860-664-0285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHRISTIANSON",
        "first_name": "ELISHA",
        "middle_name": "E",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-27",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "5899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.