Healthcare Provider Details

I. General information

NPI: 1972439503
Provider Name (Legal Business Name): ELISE MATOS FLOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 PALM COAST PARKWAY SUITES 6/7
PALM COAST FL
32137-4739
US

IV. Provider business mailing address

1029 DORADO DR
ST AUGUSTINE FL
32086-7086
US

V. Phone/Fax

Practice location:
  • Phone: 386-951-3044
  • Fax:
Mailing address:
  • Phone: 109-045-9927
  • Fax: 109-045-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: