Provider Demographics
NPI:1669245957
Name:TUDOR, ELENA T (CNA)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:T
Last Name:TUDOR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6315
Mailing Address - Country:US
Mailing Address - Phone:954-662-4719
Mailing Address - Fax:
Practice Address - Street 1:1921 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6315
Practice Address - Country:US
Practice Address - Phone:954-662-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229629251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health