Provider Demographics
NPI:1205095544
Name:FEDORA ELIPE
Entity type:Organization
Organization Name:FEDORA ELIPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FEDORA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIPE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-556-1875
Mailing Address - Street 1:7547 W 24TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6515
Mailing Address - Country:US
Mailing Address - Phone:305-556-1875
Mailing Address - Fax:866-475-1809
Practice Address - Street 1:7547 W 24TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6515
Practice Address - Country:US
Practice Address - Phone:305-556-1875
Practice Address - Fax:866-475-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN92383593140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric