Provider Demographics
NPI:1700420601
Name:HALE, ELENA RENEE (ARNP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:RENEE
Last Name:HALE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 HARTFORD DR NW
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6440
Mailing Address - Country:US
Mailing Address - Phone:941-740-6100
Mailing Address - Fax:
Practice Address - Street 1:693 HARTFORD DR NW
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6440
Practice Address - Country:US
Practice Address - Phone:757-880-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily