Provider Demographics
NPI:1346028198
Name:EISENLOEFFEL, MIKAELA RAE (PA)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:RAE
Last Name:EISENLOEFFEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 MALLORY CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1822
Mailing Address - Country:US
Mailing Address - Phone:321-939-0222
Mailing Address - Fax:321-939-0225
Practice Address - Street 1:2954 MALLORY CIR STE 101
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-1822
Practice Address - Country:US
Practice Address - Phone:321-939-0222
Practice Address - Fax:321-939-0225
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117804363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical