Provider Demographics
NPI:1942645296
Name:CHONILLO, ELIZABETH WHITNEY (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WHITNEY
Last Name:CHONILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:WHITNEY
Other - Last Name:SAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1746 SW 108TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7172
Mailing Address - Country:US
Mailing Address - Phone:954-465-9314
Mailing Address - Fax:
Practice Address - Street 1:1746 SW 108TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-7172
Practice Address - Country:US
Practice Address - Phone:954-465-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2904702163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse