Provider Demographics
NPI:1417475294
Name:ELORTONDO, KAYLA RENEE (PA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:ELORTONDO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RENEE
Other - Last Name:SPECTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1401 OVEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7959
Mailing Address - Country:US
Mailing Address - Phone:850-765-8623
Mailing Address - Fax:850-765-0118
Practice Address - Street 1:1401 OVEN PARK DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7959
Practice Address - Country:US
Practice Address - Phone:850-765-8623
Practice Address - Fax:850-765-0118
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9110600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant