Healthcare Provider Details

I. General information

NPI: 1366748493
Provider Name (Legal Business Name): ELIZABETH PAIGE ULCAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/21/2025
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N. FEDERAL HWY
FORT LAUDERDALE FL
33308-4603
US

IV. Provider business mailing address

2006 HOGBACK RD SUITE 5A
ANN ARBOR MI
48105-9750
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8000
  • Fax:
Mailing address:
  • Phone: 734-263-2414
  • Fax: 734-773-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11018283
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number251168
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: