Healthcare Provider Details

I. General information

NPI: 1417572280
Provider Name (Legal Business Name): ELIZABETH PATRICIA COULTAS BLOWERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH COULTAS

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SE OCEAN BLVD STE 102
STUART FL
34994-2236
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-4061
  • Fax: 772-287-4176
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME177390
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME177390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: