Provider Demographics
NPI:1043521057
Name:ELMORE, GAIL ELAINE (PCA)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ELAINE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10526 NEWBURY CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-7241
Mailing Address - Country:US
Mailing Address - Phone:239-603-3089
Mailing Address - Fax:
Practice Address - Street 1:10526 NEWBURY CT
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-7241
Practice Address - Country:US
Practice Address - Phone:239-603-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker