1821045352 NPI number — MRS. ELINA S BELILOVSKIY FNP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821045352 NPI number — MRS. ELINA S BELILOVSKIY FNP

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BELILOVSKIY

Provider First Name:

ELINA

Provider Middle Name:

S

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

FNP

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1821045352

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/10/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 25487

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SARASOTA

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

34277-2487

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

941-202-5342

Provider Business Mailing Address Fax Number:

855-253-4836

Provider First Line Business Practice Location Address:

425 COMMERCIAL CT

Provider Second Line Business Practice Location Address:

SUITE 112

Provider Business Practice Location Address City Name:

VENICE

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

34292

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

941-400-9974

Provider Business Practice Location Address Fax Number:

941-921-0957

Provider Enumeration Date:

05/30/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363LF0000X , with the licence number:  233160 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LF0000X , with the licence number: ARNP9246237 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0322342 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1224573 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: NP4186 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: P937666 . This is a "OPTIMUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P997746 . This is a "FREEDOM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P01808685 . This is a "CLEAR HEALTH ALLIANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 308093500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 398533 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P01379839 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: Y103B . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".