Provider Demographics
NPI:1962512798
Name:ELLIOTT, PATRICIA DARLENE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DARLENE
Last Name:ELLIOTT
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 1:1726 MEDICAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1426
Mailing Address - Country:US
Mailing Address - Phone:239-513-1992
Mailing Address - Fax:239-513-9022
Practice Address - Street 1:1726 MEDICAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-513-1992
Practice Address - Fax:239-513-9022
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12289207VG0400X
FLME126102207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021539400Medicaid
FLU6Z44OtherBCBS
AL51003211OtherBCBS
AL009933573Medicaid
AL051557128Medicare ID - Type Unspecified
FLU6Z44OtherBCBS