Provider Demographics
NPI:1669409520
Name:SADEGHI, ELAINE L (ARNP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:L
Last Name:SADEGHI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 FRIENDSHIP LN
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4538
Mailing Address - Country:US
Mailing Address - Phone:813-949-7532
Mailing Address - Fax:
Practice Address - Street 1:1020 FRIENDSHIP LN
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4538
Practice Address - Country:US
Practice Address - Phone:813-949-7532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1159762363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care