Provider Demographics
NPI:1023379765
Name:COHEN, ELYSE HOLLY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:HOLLY
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12250 TAMIAMI TRL E STE 208
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8421
Mailing Address - Country:US
Mailing Address - Phone:239-980-5892
Mailing Address - Fax:833-471-4783
Practice Address - Street 1:12250 TAMIAMI TRL E STE 208
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8421
Practice Address - Country:US
Practice Address - Phone:239-980-5892
Practice Address - Fax:833-471-4783
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124355207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015617000Medicaid
FL150ZSOtherFLORIDA BLUE