Provider Demographics
NPI:1063676278
Name:MURPHY, ELAINE C
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:C
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:C
Other - Last Name:GOSSELIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:129 BEAU RIVAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176
Mailing Address - Country:US
Mailing Address - Phone:386-441-7899
Mailing Address - Fax:386-441-7899
Practice Address - Street 1:129 BEAU RIVAGE DRIVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176
Practice Address - Country:US
Practice Address - Phone:386-441-7899
Practice Address - Fax:386-441-7899
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X372600000X
FL385HR2050X385H00000X
372500000X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681124898Medicaid
FL681124898OtherMEDWAIVER PROVIDER
FL681124896OtherMEDWAIVER PROVIDER NUMBER