Provider Demographics
NPI:1275080483
Name:ELISCARD, JONALDINE
Entity Type:Individual
Prefix:
First Name:JONALDINE
Middle Name:
Last Name:ELISCARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 MEADOW GLADE DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-5102
Mailing Address - Country:US
Mailing Address - Phone:941-565-9193
Mailing Address - Fax:
Practice Address - Street 1:934 MEADOW GLADE DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5102
Practice Address - Country:US
Practice Address - Phone:941-565-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906877372500000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home