Healthcare Provider Details

I. General information

NPI: 1700328515
Provider Name (Legal Business Name): ELISE CHRISTINE BJELICA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 LAKE MIRIAM DR STE 1
LAKELAND FL
33813-2180
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 863-647-2333
  • Fax: 863-393-1995
Mailing address:
  • Phone: 407-875-2080
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9303546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: