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General NPI Number Information
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NPI Number | 1477897338
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Entity Type | Individual
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Provider Name | KATRINA PAM ELEFTHEROPOULOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 05/30/2014
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Provider Practice Location Address
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Address Line | 12311 SAN JOSE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32223-2673
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Country | US
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Telephone | 904-262-7211
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Fax | 904-262-6995
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Provider Business Mailing Address
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Address Line | PO BOX 61148
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City | JACKSONVILLE
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State | FL
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Zip | 32236-1148
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Country | US
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Telephone | 904-400-6100
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Fax | 904-400-6102
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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 | PA9106866
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License Number State | FL
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