Provider Demographics
NPI:1154682433
Name:LEGORRETA, ELIZABETH M BEHNAN (ARNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M BEHNAN
Last Name:LEGORRETA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 BRUCE B. DOWNS BLVD
Mailing Address - Street 2:STE. 106
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613
Mailing Address - Country:US
Mailing Address - Phone:813-632-8861
Mailing Address - Fax:813-977-1742
Practice Address - Street 1:13701 BRUCE B. DOWNS BLVD.
Practice Address - Street 2:STE. 106
Practice Address - City:TAMMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-632-8861
Practice Address - Fax:813-977-1742
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily