Healthcare Provider Details

I. General information

NPI: 1720686082
Provider Name (Legal Business Name): TATIANA C ELIZEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1911
US

IV. Provider business mailing address

1113 NW 23RD AVE
CHIEFLAND FL
32626-1911
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-9475
  • Fax:
Mailing address:
  • Phone: 352-493-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11008915
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: