Provider Demographics
NPI:1316810179
Name:DERMINER, ELIZABETH MICHELLE (CNM/WHNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:DERMINER
Suffix:
Gender:F
Credentials:CNM/WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-3079
Mailing Address - Country:US
Mailing Address - Phone:785-717-5074
Mailing Address - Fax:
Practice Address - Street 1:1165 8TH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3079
Practice Address - Country:US
Practice Address - Phone:785-717-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104907421363LW0102X
FL10381367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health