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General NPI Number Information
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NPI Number | 1821496324
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Entity Type | Individual
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Provider Name | JOHN WESLEY ELLIOTT III CPNP-AC
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Gender | Male
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 601 5TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4804
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Country | US
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Telephone | 727-767-3153
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Fax | 727-767-2265
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Provider Business Mailing Address
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Address Line | 501 6TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-3153
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Fax | 727-767-2265
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | COA-16296-NP
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP9398367
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License Number State | FL
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