Icaza, Elisa Rosario

Icaza, Elisa Rosario is an individual health care provider with primary practice located at 1700 66Th St. N. Suite 510, St. Petersburg FL 33710-5512. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Primary Care, which is considered as her primary health care specialty. Icaza, Elisa Rosario can be contacted via phone (727) 384-2479.

Contact Information

Primary practice address
1700 66Th St. N. Suite 510 St. Petersburg FL 33710-5512
Phone: (727) 384-2479
Fax: (727) 384-3573
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X APRN1701762 Florida

Profile Details

NPI number 1194770271
LBN Legal business name Icaza, Elisa Rosario
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2006
Last updated Oct 25th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194770271 NPPES
Florida MEDICAID 304992200

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