Provider Demographics
NPI:1386082667
Name:NASI, ETLEVA (MD)
Entity type:Individual
Prefix:
First Name:ETLEVA
Middle Name:
Last Name:NASI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701-32 SAN JOSE BLVD
Mailing Address - Street 2:#103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-262-9075
Mailing Address - Fax:904-262-9076
Practice Address - Street 1:11701-32 SAN JOSE BLVD
Practice Address - Street 2:#103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-262-9075
Practice Address - Fax:904-262-9076
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine