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General NPI Number Information
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NPI Number | 1457917791
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Entity Type | Individual
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Provider Name | ELPITHA K TSISKAKIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 5415 PARK CENTRAL CT
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City | NAPLES
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State | FL
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Zip | 34109-6005
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Country | US
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Telephone | 239-936-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 4944 ESPLANADE ST
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3986
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Country | US
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Telephone | 239-438-6716
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 56550
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9115892
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License Number State | FL
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