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General NPI Number Information
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NPI Number | 1417410226
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Entity Type | Individual
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Provider Name | ELYSEE EDMOND PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 3304 SW 34TH CIRCLE SUITE 103
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City | OCALA
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State | FL
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Zip | 34474-3357
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Country | US
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Telephone | 352-401-7575
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Fax | 352-401-7577
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Provider Business Mailing Address
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Address Line | 4881 NW 8TH AVE SUITE 2
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City | GAINESVILLE
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State | FL
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Zip | 32605-4582
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Country | US
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Telephone | 352-416-1082
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Fax | 352-373-6144
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1597
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PACN80
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TPPA535
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10352
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9629527
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License Number State | FL
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