Provider Demographics
NPI:1003569179
Name:MCKELVIN, EUGENIA LEONTINA (NP)
Entity type:Individual
Prefix:MRS
First Name:EUGENIA
Middle Name:LEONTINA
Last Name:MCKELVIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5529 N MILITARY TRL APT 1508
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3495
Mailing Address - Country:US
Mailing Address - Phone:240-419-8750
Mailing Address - Fax:
Practice Address - Street 1:5529 N MILITARY TRL APT 1508
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3495
Practice Address - Country:US
Practice Address - Phone:240-419-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily