Provider Demographics
NPI:1992179873
Name:DEREMER COOK, ELAINE (PE)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:DEREMER COOK
Suffix:
Gender:F
Credentials:PE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-6611
Mailing Address - Country:US
Mailing Address - Phone:321-208-7989
Mailing Address - Fax:
Practice Address - Street 1:1520 PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-6611
Practice Address - Country:US
Practice Address - Phone:321-208-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57426171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47-3662486OtherHANDYPRO OF THE SPACE COAST