Individual
ELIZABETH MARGARET ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 POPE AVE NW STE 200, WINTER HAVEN, FL 33881-4679
(863) 299-2630
Mailing address
5536 ANSLEY WAY, MOUNT DORA, FL 32757-8000
(352) 400-8457
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 9105563
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002747500
—
FL
01
—
1780221774
NRCME
—
01
—
342264
AVMED
FL
01
—
PA-9105563
DEPARTMENT OF HEALTH
FL
01
—
PAX 0008401
DOH PRESCRIBING
FL
01
—
YO5FR
BCBS
FL
Enumeration date
06/21/2010
Last updated
11/18/2022
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