Healthcare Provider Details

I. General information

NPI: 1790310456
Provider Name (Legal Business Name): ELIZABETH VALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 TECH DATA DR STE 101
CLEARWATER FL
33760-3122
US

IV. Provider business mailing address

339 BROADWAY
DUNEDIN FL
34698-7514
US

V. Phone/Fax

Practice location:
  • Phone: 727-210-8191
  • Fax:
Mailing address:
  • Phone: 646-379-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number9367567
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11007138
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9367567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: