Healthcare Provider Details

I. General information

NPI: 1831719582
Provider Name (Legal Business Name): ELSA LESLEY TCHOUAMBOU POUGOUE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 W BROWARD BLVD
PLANTATION FL
33324-2701
US

IV. Provider business mailing address

8201 W BROWARD BLVD
PLANTATION FL
33324-2701
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5980
  • Fax: 352-376-4975
Mailing address:
  • Phone: 352-333-5980
  • Fax: 352-376-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS21323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: