Provider Demographics
NPI:1881086395
Name:ENLOE, DAVID (CST/CSFA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ENLOE
Suffix:
Gender:M
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 BROOKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4725
Mailing Address - Country:US
Mailing Address - Phone:407-431-1696
Mailing Address - Fax:
Practice Address - Street 1:2253 BROOKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4725
Practice Address - Country:US
Practice Address - Phone:407-431-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
157385246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant