Provider Demographics
NPI:1376933192
Name:FREDERIC, ELSA ASHLEY (APRN)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:ASHLEY
Last Name:FREDERIC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SW 117TH TERRACE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1054
Mailing Address - Country:US
Mailing Address - Phone:786-718-3813
Mailing Address - Fax:
Practice Address - Street 1:230 SW 117TH TERRACE UNIT 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1054
Practice Address - Country:US
Practice Address - Phone:786-718-3813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily