Healthcare Provider Details

I. General information

NPI: 1811650690
Provider Name (Legal Business Name): ELENA VLADIMIROVNA GOLOUBEVA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N DEAN RD
ORLANDO FL
32825-3710
US

IV. Provider business mailing address

14180 ALDFORD DR
WINTER GARDEN FL
34787-4777
US

V. Phone/Fax

Practice location:
  • Phone: 407-384-7388
  • Fax: 407-384-7391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11015411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: