Provider Demographics
NPI:1316086861
Name:MACDERMOTT, ELIZABETH (MSM, ARNP, RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MACDERMOTT
Suffix:
Gender:F
Credentials:MSM, ARNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2123
Mailing Address - Country:US
Mailing Address - Phone:407-246-6620
Mailing Address - Fax:407-246-6621
Practice Address - Street 1:101 E MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2123
Practice Address - Country:US
Practice Address - Phone:407-246-6620
Practice Address - Fax:407-246-6621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 432902363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ09850Medicare UPIN