Healthcare Provider Details

I. General information

NPI: 1164202016
Provider Name (Legal Business Name): ELSA MCDANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N DIXIE HWY
POMPANO BEACH FL
33060-5621
US

IV. Provider business mailing address

13251 DUPREE HILLS PL
RIVERVIEW FL
33579-7220
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-8285
  • Fax: 954-928-0040
Mailing address:
  • Phone: 719-434-0426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9538400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: