Provider Demographics
NPI:1316319452
Name:SWEET, ELENA (PA-C)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:SWEET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:305-245-8050
Mailing Address - Fax:305-245-5950
Practice Address - Street 1:3084 NE 41ST TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6619
Practice Address - Country:US
Practice Address - Phone:305-245-8050
Practice Address - Fax:305-245-5950
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9108908363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016022200Medicaid