Doctor Name: | ELI BILLETER |
NPI Number: | 1063817948 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | ARNP9192714 |
Business Practice Address: | 128 Moultrie Crossing Ln Saint Augustine, FL - 320865242 |
Business Phone Number: | 9048195155 |
Business Fax Number: | |
Mailing Address: | 128 Moultrie Crossing Ln, SAINT AUGUSTINE |
State: | FL |
Postal Code: | 320865242 |
Phone Number: | 9048195155 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2014 |
NPI Last Update Date: | 11/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | ARNP9192714 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |