Healthcare Provider Details

I. General information

NPI: 1063575124
Provider Name (Legal Business Name): ELIZABETH HOPE JOZAITIS ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 STATE ROAD 54 STE 307
TRINITY FL
34655-1810
US

IV. Provider business mailing address

9332 STATE ROAD 54 STE 307
TRINITY FL
34655-1810
US

V. Phone/Fax

Practice location:
  • Phone: 727-999-3311
  • Fax: 727-478-4966
Mailing address:
  • Phone: 727-999-3311
  • Fax: 727-478-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG86360
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG86360
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME155836
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME155836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: