Provider Demographics
NPI:1487685822
Name:MCCREA, ERLINDA S (MD)
Entity Type:Individual
Prefix:
First Name:ERLINDA
Middle Name:S
Last Name:MCCREA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 VININGS WAY BLVD
Mailing Address - Street 2:#5301
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5357
Mailing Address - Country:US
Mailing Address - Phone:850-650-7361
Mailing Address - Fax:
Practice Address - Street 1:280 VININGS WAY BLVD
Practice Address - Street 2:#5301
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5357
Practice Address - Country:US
Practice Address - Phone:850-650-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76206174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57646Medicare UPIN