Provider Demographics
NPI:1699335794
Name:ELZA, MICHAELA C
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:C
Last Name:ELZA
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 1:10507 CYNDEE LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4801
Mailing Address - Country:US
Mailing Address - Phone:813-361-6434
Mailing Address - Fax:
Practice Address - Street 1:10507 CYNDEE LN
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4801
Practice Address - Country:US
Practice Address - Phone:813-361-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-22-14026106E00000X
FLRBT-19-89973106S00000X
FL1-24-75835103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician