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General NPI Number Information
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NPI Number | 1144845413
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Entity Type | Individual
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Provider Name | STASE ELENA MICHOTA
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Gender | Female
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 6901 22ND AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-3943
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Country | US
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Telephone | 727-341-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 1285 79TH ST S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33707-2718
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Country | US
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Telephone | 727-492-8240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11001287
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License Number State | FL
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