Provider Demographics
NPI:1558385104
Name:DRISSEL, ELIZABETH A (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:DRISSEL
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 1:550 POPE AVE NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881
Mailing Address - Country:US
Mailing Address - Phone:863-299-2630
Mailing Address - Fax:863-969-0711
Practice Address - Street 1:550 POPE AVE NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881
Practice Address - Country:US
Practice Address - Phone:863-299-2630
Practice Address - Fax:863-969-0711
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant