Provider Demographics
NPI:1588938989
Name:ELDRIDGE, ELENA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIE
Last Name:ELDRIDGE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:MARIE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1418 BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6110
Mailing Address - Country:US
Mailing Address - Phone:813-252-0171
Mailing Address - Fax:
Practice Address - Street 1:1418 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6110
Practice Address - Country:US
Practice Address - Phone:813-252-0171
Practice Address - Fax:813-291-7329
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9179672363LP0200X
FL9179672363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104418100Medicaid