Provider Demographics
NPI:1649543976
Name:QUINTANA ORONOZ, ELISA MERCEDES (MD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:MERCEDES
Last Name:QUINTANA ORONOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:MERCEDES
Other - Last Name:GARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3131 N MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2008
Mailing Address - Country:US
Mailing Address - Phone:727-726-8871
Mailing Address - Fax:727-723-9055
Practice Address - Street 1:3131 N MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2008
Practice Address - Country:US
Practice Address - Phone:727-726-8871
Practice Address - Fax:727-723-9055
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013023400Medicaid
FLI13DUOtherFLORIDA BLUE
FL4987653OtherAETNA
FL6229132OtherUNITED
FL398859OtherAVMED