Provider Demographics
NPI:1396854501
Name:BUCKMAN, ELCHA (ARNP PHD)
Entity Type:Individual
Prefix:DR
First Name:ELCHA
Middle Name:
Last Name:BUCKMAN
Suffix:
Gender:F
Credentials:ARNP PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 GALT OCEAN DR
Mailing Address - Street 2:1704
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7045
Mailing Address - Country:US
Mailing Address - Phone:781-799-2110
Mailing Address - Fax:
Practice Address - Street 1:3430 GALT OCEAN DR
Practice Address - Street 2:1704
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7045
Practice Address - Country:US
Practice Address - Phone:781-799-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1918912163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY38001AMedicare ID - Type Unspecified
FLS57695Medicare UPIN