Provider Demographics
NPI:1912132275
Name:ENLOW, ERIC EUGENE (CFA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:EUGENE
Last Name:ENLOW
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 EAGLE CHASE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1704
Mailing Address - Country:US
Mailing Address - Phone:727-515-4558
Mailing Address - Fax:727-562-9497
Practice Address - Street 1:104 DUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3701
Practice Address - Country:US
Practice Address - Phone:727-515-4558
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102582246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist