Provider Demographics
NPI:1508627589
Name:ELLIOTT, ELISABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 2ND ST E APT A
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4772
Mailing Address - Country:US
Mailing Address - Phone:805-350-2027
Mailing Address - Fax:
Practice Address - Street 1:11225 2ND ST E APT A
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706-4772
Practice Address - Country:US
Practice Address - Phone:805-350-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant