Provider Demographics
NPI:1578833927
Name:ELIZABETH M. BODLE, A.R.N.P., P.A.
Entity Type:Organization
Organization Name:ELIZABETH M. BODLE, A.R.N.P., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BODLE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:317-439-5924
Mailing Address - Street 1:770 CLAUGHTON ISLAND DR
Mailing Address - Street 2:APT 1015
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2617
Mailing Address - Country:US
Mailing Address - Phone:305-275-5008
Mailing Address - Fax:305-275-5008
Practice Address - Street 1:9220 SW 72ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3259
Practice Address - Country:US
Practice Address - Phone:305-275-1700
Practice Address - Fax:305-275-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9266707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty