Provider Demographics
NPI:1851500482
Name:ELLIOTT, MARSHA ELAINE
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:ELAINE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14198 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3009
Mailing Address - Country:US
Mailing Address - Phone:954-431-9588
Mailing Address - Fax:954-436-7407
Practice Address - Street 1:14198 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3009
Practice Address - Country:US
Practice Address - Phone:954-431-9588
Practice Address - Fax:954-436-7407
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3265322163W00000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program