Provider Demographics
NPI:1801837588
Name:CHILDRESS, ELSIE SHARON (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:SHARON
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:SHARON
Other - Last Name:CHANCEY HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1006 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2966
Mailing Address - Country:US
Mailing Address - Phone:863-453-3121
Mailing Address - Fax:863-382-1433
Practice Address - Street 1:1006 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2966
Practice Address - Country:US
Practice Address - Phone:863-453-3121
Practice Address - Fax:863-382-1433
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1701242363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P59873Medicare UPIN
FLE7371VMedicare PIN