Healthcare Provider Details

I. General information

NPI: 1841282316
Provider Name (Legal Business Name): ELISA WOLFE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE SUITE 323 WEST WING
FT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

1501 NW 49TH ST SUITE 140
FT LAUDERDALE FL
33309-3723
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-5110
  • Fax: 954-355-4919
Mailing address:
  • Phone: 954-714-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP1857222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: