1497151211 NPI number — MS. ELIZABETH PERRY B.A.,H.A.S.,BC-H.I.S

Table of content: MS. ELIZABETH PERRY B.A.,H.A.S.,BC-H.I.S (NPI 1497151211)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497151211 NPI number — MS. ELIZABETH PERRY B.A.,H.A.S.,BC-H.I.S

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
PERRY

Provider First Name:
ELIZABETH

Provider Middle Name:

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
B.A.,H.A.S.,BC-H.I.S

Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1497151211

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
11/05/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 TAMIAMI TRL

Provider Second Line Business Mailing Address:
SUITE 109

Provider Business Mailing Address City Name:
PORT CHARLOTTE

Provider Business Mailing Address State Name:
FL

Provider Business Mailing Address Postal Code:
33948-2180

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
941-743-5211

Provider Business Mailing Address Fax Number:
941-743-6380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 TAMIAMI TRL

Provider Second Line Business Practice Location Address:
SUITE 109

Provider Business Practice Location Address City Name:
PORT CHARLOTTE

Provider Business Practice Location Address State Name:
FL

Provider Business Practice Location Address Postal Code:
33948-2180

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
941-743-5211

Provider Business Practice Location Address Fax Number:
941-743-6380

Provider Enumeration Date:
11/05/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 237700000X , with the licence number: AS 3470 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .