Provider Demographics
NPI:1003030289
Name:MERCIER, ELIZMA EKSTEEN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZMA
Middle Name:EKSTEEN
Last Name:MERCIER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 SW 93RD PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5993
Mailing Address - Country:US
Mailing Address - Phone:352-495-0844
Mailing Address - Fax:
Practice Address - Street 1:5612 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3332
Practice Address - Country:US
Practice Address - Phone:352-376-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103884363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO9719OtherHF MA
FL114127200Medicaid