Provider Demographics
NPI:1174267769
Name:ELIZARRARAS, FERNANDO A
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:A
Last Name:ELIZARRARAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 COMMERCE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1549
Mailing Address - Country:US
Mailing Address - Phone:407-989-4040
Mailing Address - Fax:407-989-4040
Practice Address - Street 1:311 COMMERCE CENTER DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1549
Practice Address - Country:US
Practice Address - Phone:407-989-4040
Practice Address - Fax:407-989-4040
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL1-25-85375103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114072100Medicaid