Healthcare Provider Details

I. General information

NPI: 1518780709
Provider Name (Legal Business Name): ELISHA SWANNER BSN, RNFA, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BAPTIST WAY
PENSACOLA FL
32503-2254
US

IV. Provider business mailing address

6720 PASO DE CORTEZ CT
NAVARRE FL
32566-8974
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-8478
  • Fax: 448-227-8478
Mailing address:
  • Phone: 850-758-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9409015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: