Provider Demographics
NPI:1508182353
Name:PECTOL, ELIZABETH GLADYS (ARNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GLADYS
Last Name:PECTOL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 SE PSL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952
Mailing Address - Country:US
Mailing Address - Phone:772-337-7676
Mailing Address - Fax:772-337-9034
Practice Address - Street 1:2100 SE OCEAN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3332
Practice Address - Country:US
Practice Address - Phone:772-337-7676
Practice Address - Fax:772-337-9034
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2219542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE323ZMedicare PIN