Provider Demographics
NPI:1669912507
Name:MORJAIN, ELISE CARA (PA-C)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:CARA
Last Name:MORJAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 N OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7527
Mailing Address - Country:US
Mailing Address - Phone:954-568-1818
Mailing Address - Fax:
Practice Address - Street 1:2985 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7527
Practice Address - Country:US
Practice Address - Phone:954-568-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-25
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant