Provider Demographics
NPI:1104077841
Name:ELLIOTT, DENISE (RN CRNI)
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RN CRNI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 N WICKHAM RD STE 138
Mailing Address - Street 2:PMB 147
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8127
Mailing Address - Country:US
Mailing Address - Phone:186-654-5742
Mailing Address - Fax:
Practice Address - Street 1:2447 N WICKHAM RD STE 138
Practice Address - Street 2:PMB 147
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8127
Practice Address - Country:US
Practice Address - Phone:186-654-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9198810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist