Provider Demographics
NPI:1811650690
Name:GOLOUBEVA, ELENA VLADIMIROVNA (NP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:VLADIMIROVNA
Last Name:GOLOUBEVA
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 1:14180 ALDFORD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N DEAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3710
Practice Address - Country:US
Practice Address - Phone:407-384-7388
Practice Address - Fax:407-384-7391
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11015411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner