MEDICARE: DR. ELISE LUTGARDE EVERAERT

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	PS63911	FL

General Provider Information

NPI Number	:	1952044737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISE LUTGARDE EVERAERT

Provider Business Mailing Address
First Line	:	4400 S HIGHWAY 27
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5383
Country	:	US
Telephone Number	:	352-394-8029
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 S HIGHWAY 27
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5383
Country	:	US
Telephone Number	:	352-394-8029
Fax Number	:

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

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	12/18/2022

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