Healthcare Provider Details

I. General information

NPI: 1891756904
Provider Name (Legal Business Name): KERRI L ELFVIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 BOULEVARD UFJP - DEPT. OF CHFM/ SHANDS TOTAL CARE CLINIC
JACKSONVILLE FL
32206-4382
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1040
  • Fax: 904-244-8952
Mailing address:
  • Phone: 904-244-3199
  • Fax: 904-244-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: