Provider Demographics
NPI:1023494069
Name:HOELLERICH, ELISA (PA)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:HOELLERICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 GLADES RD STE 228W
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7391
Mailing Address - Country:US
Mailing Address - Phone:561-342-7391
Mailing Address - Fax:
Practice Address - Street 1:1945 W WILSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7927
Practice Address - Country:US
Practice Address - Phone:773-769-9040
Practice Address - Fax:847-866-8990
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant