Healthcare Provider Details

I. General information

NPI: 1154313138
Provider Name (Legal Business Name): ELISA HANSON CASEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISA BETH HANSON ARNP

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 CAPITAL CIR NE STE 200
TALLAHASSEE FL
32308-8402
US

IV. Provider business mailing address

1965 CAPITAL CIR NE STE 200
TALLAHASSEE FL
32308-8402
US

V. Phone/Fax

Practice location:
  • Phone: 850-656-2006
  • Fax: 850-656-2820
Mailing address:
  • Phone: 850-656-2006
  • Fax: 850-656-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2749512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: