Healthcare Provider Details

I. General information

NPI: 1770911711
Provider Name (Legal Business Name): ELISSA BUXTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6307
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-357-0520
  • Fax: 813-554-8480
Mailing address:
  • Phone: 727-281-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3291602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: