Provider Demographics
NPI:1053043588
Name:ZITKA, ELISE MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MARIE
Last Name:ZITKA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 HIBISCUS WAY
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3042
Mailing Address - Country:US
Mailing Address - Phone:386-585-0049
Mailing Address - Fax:
Practice Address - Street 1:1575 DETRICK AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2042
Practice Address - Country:US
Practice Address - Phone:386-603-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician