Provider Demographics
NPI:1649248964
Name:ELLIOTT, JOY COBURN (CRNA)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:COBURN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:MARIE
Other - Last Name:COBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:851 TRAFALGAR COURT
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-667-0444
Mailing Address - Fax:407-667-4338
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP ANESTHESIA DEPT.
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-393-5582
Practice Address - Fax:904-244-4908
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3244722367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000978975DMedicaid
FL3051633-00Medicaid
GA000978975AMedicaid
GA000978975DMedicaid
FL430078384Medicare PIN