Healthcare Provider Details

I. General information

NPI: 1962512798
Provider Name (Legal Business Name): PATRICIA DARLENE ELLIOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 MEDICAL BLVD STE 101
NAPLES FL
34110
US

IV. Provider business mailing address

1726 MEDICAL BLVD STE 101
NAPLES FL
34110-1426
US

V. Phone/Fax

Practice location:
  • Phone: 239-513-1992
  • Fax: 239-513-9022
Mailing address:
  • Phone: 239-513-1992
  • Fax: 239-513-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number12289
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME126102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: