Provider Demographics
NPI:1164853594
Name:ELMSTROM, CARA LEIGH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:LEIGH
Last Name:ELMSTROM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CARA
Other - Middle Name:LEIGH
Other - Last Name:ROSENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12309 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-432-6595
Mailing Address - Fax:954-432-6266
Practice Address - Street 1:12309 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:954-432-6595
Practice Address - Fax:954-432-6266
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107550207R00000X, 207RC0200X, 207RP1001X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease