Healthcare Provider Details

I. General information

NPI: 1386346146
Provider Name (Legal Business Name): MAGNOLIA MARIE ELIZABETH MCELYEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JFK DR STE 210
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

1009 WATER TOWER WAY APT 206
HYPOLUXO FL
33462-6212
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-1450
  • Fax: 561-548-1459
Mailing address:
  • Phone: 561-913-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME181989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: