Provider Demographics
NPI:1013041714
Name:CHUNG, ELIZABETH STRAKA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STRAKA
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 W SWANN AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4039
Mailing Address - Country:US
Mailing Address - Phone:813-876-7073
Mailing Address - Fax:
Practice Address - Street 1:2605 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4039
Practice Address - Country:US
Practice Address - Phone:813-876-7073
Practice Address - Fax:813-879-3737
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH305688363LA2200X
FLARNP 9293363363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health