Provider Demographics
NPI:1205856879
Name:PROSSER, ELIZABETH E (DC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:PROSSER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3161
Mailing Address - Country:US
Mailing Address - Phone:941-484-0008
Mailing Address - Fax:941-484-5899
Practice Address - Street 1:320 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3161
Practice Address - Country:US
Practice Address - Phone:941-484-0008
Practice Address - Fax:941-484-5899
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8942111N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70289OtherBLUE CROSS BLUE SHIELD
FL70289ZMedicare ID - Type Unspecified
FL70289OtherBLUE CROSS BLUE SHIELD