MEDICARE: ELIZABETH WARREN SELVA

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	183500000X	Pharmacist	PS56461	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS56461	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1598360430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WARREN SELVA

Provider Business Mailing Address
First Line	:	5400 NW 39TH AVE APT E29
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6948
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2449 E SILVER SPRINGS BLVD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-6908
Country	:	US
Telephone Number	:	352-401-9492
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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