MEDICARE: ELISE KIRALYN POWELL

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	363LF0000X	Family Nurse Practitioner	11030317	FL

General Provider Information

NPI Number	:	1528838000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE KIRALYN POWELL

Provider Business Mailing Address
First Line	:	15501 BRUCE B DOWNS BLVD APT 1312
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1307
Country	:	US
Telephone Number	:	605-216-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	15501 BRUCE B DOWNS BLVD APT 1312
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1307
Country	:	US
Telephone Number	:	605-216-9950
Fax Number	:

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

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/04/2024

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