Provider Demographics
NPI:1134127814
Name:KENNEDY, ELSIA LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:ELSIA
Middle Name:LEE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CONTINENTAL
Other - Middle Name:ANESTHESIA
Other - Last Name:PROFESSIONALS,P.A.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3101 SW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7447
Mailing Address - Country:US
Mailing Address - Phone:352-274-0603
Mailing Address - Fax:
Practice Address - Street 1:3101 SW 34TH AVE
Practice Address - Street 2:905-446
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7447
Practice Address - Country:US
Practice Address - Phone:352-274-0603
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1774372367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2852AMedicare ID - Type Unspecified