Provider Demographics
NPI:1962894691
Name:ELLIOTT, EMILY JERNIGAN (DO)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JERNIGAN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:JERNIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:220 HOVEY RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-1044
Mailing Address - Country:US
Mailing Address - Phone:850-452-4554
Mailing Address - Fax:
Practice Address - Street 1:220 HOVEY RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-1044
Practice Address - Country:US
Practice Address - Phone:850-452-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204576171000000X, 2084N0400X, 2084N0600X
FL209932084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No171000000XOther Service ProvidersMilitary Health Care Provider
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology