Healthcare Provider Details

I. General information

NPI: 1497865323
Provider Name (Legal Business Name): ELIZABETH A. MCDONOUGH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH A. BETHEA PA-C

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W GRANADA BLVD STE 44
ORMOND BEACH FL
32174-9406
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 866-400-3376
  • Fax: 386-898-0551
Mailing address:
  • Phone: 866-400-3376
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: