Healthcare Provider Details

I. General information

NPI: 1609923077
Provider Name (Legal Business Name): ELIZABETH BJONSTAD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

445 E BAY AVE
LONGWOOD FL
32750-5268
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax: 407-648-4150
Mailing address:
  • Phone: 407-332-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: