Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | CRT83090 | FL |
NPI | 1336769017 |
---|---|
Provider Name | Ms. Lisa C Elliott |
First Address | Trenton, FL 32693-4720 |
Second Address | Gainesville, FL 32608-1135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2020 |
Last Update Date | 22/04/2020 |