Healthcare Provider Details

I. General information

NPI: 1447946587
Provider Name (Legal Business Name): ELIZABETH KOLICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 WEKIVA COMMONS CIR
APOPKA FL
32712-3645
US

IV. Provider business mailing address

1139 DEGRAW DR
APOPKA FL
32712-6406
US

V. Phone/Fax

Practice location:
  • Phone: 800-827-7546
  • Fax:
Mailing address:
  • Phone: 561-891-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9117293
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: