Provider Demographics
NPI:1346293255
Name:ZENNI, ELISA A (MD)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:A
Last Name:ZENNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-633-0355
Mailing Address - Fax:904-383-1413
Practice Address - Street 1:515 WEST 6TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206
Practice Address - Country:US
Practice Address - Phone:904-253-1080
Practice Address - Fax:904-253-1953
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME68619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378413400Medicaid
FL3784134-00Medicaid
FL378413400Medicaid
FL27722XMedicare PIN