MEDICARE: ELISHA PRANCKEVICIUS

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	363LP2300X	Primary Care Nurse Practitioner	11040737	FL

General Provider Information

NPI Number	:	1609766617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISHA PRANCKEVICIUS

Provider Business Mailing Address
First Line	:	4207 S DALE MABRY HWY UNIT 4207
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1434
Country	:	US
Telephone Number	:	508-868-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 S DALE MABRY HWY UNIT 4207
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1434
Country	:	US
Telephone Number	:	508-868-6328
Fax Number	:

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

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	07/09/2025

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