Provider Demographics
NPI:1235217191
Name:KESTERSON, ELENA U (PA)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:U
Last Name:KESTERSON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:941-488-5300
Mailing Address - Fax:941-412-1003
Practice Address - Street 1:1415 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3064
Practice Address - Country:US
Practice Address - Phone:941-488-5300
Practice Address - Fax:941-412-1003
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN1383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant