Provider Demographics
NPI:1083734131
Name:WIND, ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WIND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 CELEBRATION PL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4606
Mailing Address - Country:US
Mailing Address - Phone:407-303-4760
Mailing Address - Fax:407-303-4546
Practice Address - Street 1:380 CELEBRATION PL
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4606
Practice Address - Country:US
Practice Address - Phone:407-303-4760
Practice Address - Fax:407-303-4546
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO175807363L00000X
FLARNP9314420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO808601Medicare PIN