Healthcare Provider Details

I. General information

NPI: 1114477510
Provider Name (Legal Business Name): ELISA TURKO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISA DUPUIS

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 N NEBRASKA AVE
TAMPA FL
33602-2558
US

IV. Provider business mailing address

3251 3RD AVE N
ST PETERSBURG FL
33713-8506
US

V. Phone/Fax

Practice location:
  • Phone: 813-232-3808
  • Fax: 727-327-7670
Mailing address:
  • Phone: 727-321-3854
  • Fax: 727-327-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR210288
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11001790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: