MEDICARE: MISS DENISE ELLIOTT RN CRNI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	RN9198810	FL

General Provider Information

NPI Number	:	1104077841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DENISE ELLIOTT RN CRNI

Provider Business Mailing Address
First Line	:	2447 N WICKHAM RD STE 138
Second Line	:	PMB 147
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8127
Country	:	US
Telephone Number	:	186-654-5742
Fax Number	:

Provider Business Practice Location Address
First Line	:	2447 N WICKHAM RD STE 138
Second Line	:	PMB 147
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8127
Country	:	US
Telephone Number	:	186-654-5742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/30/2008

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