Provider Demographics
NPI:1457130395
Name:ELLIOTT, JOSEPH BRYAN
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRYAN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 WINDING LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5660
Mailing Address - Country:US
Mailing Address - Phone:828-446-3138
Mailing Address - Fax:
Practice Address - Street 1:7306 WINDING LAKE CIR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5660
Practice Address - Country:US
Practice Address - Phone:828-446-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider