Provider Demographics
NPI:1518153840
Name:ELMSTROM, TROY ERIK (PA-C)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:ERIK
Last Name:ELMSTROM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 LAKE PARK CIR S
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7009
Mailing Address - Country:US
Mailing Address - Phone:954-825-1497
Mailing Address - Fax:954-967-8419
Practice Address - Street 1:3702 WASHINGTON ST
Practice Address - Street 2:SUITE 403
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8282
Practice Address - Country:US
Practice Address - Phone:954-967-6550
Practice Address - Fax:954-967-8419
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP36470Medicare UPIN