Provider Demographics
NPI:1982672853
Name:ELLIOT, ELIZABETH JEAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:DISHAROON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:205 DR. MARTIN LUTHER KING ST. NORTH
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3549
Mailing Address - Country:US
Mailing Address - Phone:727-824-6900
Mailing Address - Fax:727-820-4294
Practice Address - Street 1:205 DR. MARTIN LUTHER KING ST. NORTH
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3549
Practice Address - Country:US
Practice Address - Phone:727-824-6900
Practice Address - Fax:727-820-4294
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP870132363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033420100Medicaid
FLY43322 GROUP K3225Medicare ID - Type Unspecified