Provider Demographics
NPI:1619496015
Name:PERRY, ELYSE MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:MARIE
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10023 N ATHENIA DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-2601
Mailing Address - Country:US
Mailing Address - Phone:607-287-3330
Mailing Address - Fax:
Practice Address - Street 1:120 N MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-2439
Practice Address - Country:US
Practice Address - Phone:352-423-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9357642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily