Provider Demographics
NPI:1164472254
Name:ELLIOTT, JANIE R (ARNP)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:R
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:1016 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1073
Practice Address - Country:US
Practice Address - Phone:727-586-6200
Practice Address - Fax:813-635-2656
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1961102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL500023571OtherRAILROAD MEDICARE NUMBER
FL304022400Medicaid
S76253Medicare UPIN
FLE2271YMedicare PIN