Provider Demographics
NPI:1871767061
Name:FORCILUS, ELMITA (HEALTHCAREPROVIDER)
Entity type:Individual
Prefix:
First Name:ELMITA
Middle Name:
Last Name:FORCILUS
Suffix:
Gender:F
Credentials:HEALTHCAREPROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 24TH ST E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-6452
Mailing Address - Country:US
Mailing Address - Phone:941-224-2004
Mailing Address - Fax:
Practice Address - Street 1:1712 24TH ST E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-6452
Practice Address - Country:US
Practice Address - Phone:941-224-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311Z00000X
FL6906195172V00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No172V00000XOther Service ProvidersCommunity Health Worker