Provider Demographics
NPI:1427294446
Name:KRAMER, ELIZABETH NICOLE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:KRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11736 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3504
Mailing Address - Country:US
Mailing Address - Phone:813-443-4804
Mailing Address - Fax:813-443-4805
Practice Address - Street 1:11736 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3504
Practice Address - Country:US
Practice Address - Phone:813-443-4804
Practice Address - Fax:813-443-4805
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 51956225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA 51956OtherSTATE OF FLORIDA DEPT. OF HEALTH DIV OF MEDICAL QUALITY ASSURANCE