Provider Demographics
NPI:1316480460
Name:CORTES, ELVIA FIDELINA (APRN)
Entity type:Individual
Prefix:
First Name:ELVIA
Middle Name:FIDELINA
Last Name:CORTES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELVIA
Other - Middle Name:FIDELINA
Other - Last Name:GABRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 100128
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0128
Mailing Address - Country:US
Mailing Address - Phone:352-273-5484
Mailing Address - Fax:352-273-5515
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2756
Practice Address - Country:US
Practice Address - Phone:386-226-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9202289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC019429600Medicaid
FLIU944ZMedicare PIN