Provider Demographics
NPI:1720779846
Name:FOX, ELSA RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:RENEE
Last Name:FOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 WOLF RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-8391
Mailing Address - Country:US
Mailing Address - Phone:228-263-1088
Mailing Address - Fax:
Practice Address - Street 1:14001 WOLF RUN BLVD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-8391
Practice Address - Country:US
Practice Address - Phone:228-263-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905997363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care