=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942849294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ILONA LELCHITSKAYA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2020
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2116 34TH ST S
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33711-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-321-3854
-----------------------------------------------------
Fax | 727-800-5829
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 94TH AVE N STE 250
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33702-2448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-321-3854
-----------------------------------------------------
Fax | 727-800-5829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11014919
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------