Healthcare Provider Details

I. General information

NPI: 1982128146
Provider Name (Legal Business Name): NOELLE ELIZABETH LELAKUS MSN, ARNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 N DALE MABRY HWY
TAMPA FL
33614-2665
US

IV. Provider business mailing address

606 S ALBANY AVE APT 13
TAMPA FL
33606-2451
US

V. Phone/Fax

Practice location:
  • Phone: 813-558-0097
  • Fax:
Mailing address:
  • Phone: 330-936-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9385330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: