Individual
ELTA DESVARISTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13960 PLANTATION RD, FORT MYERS, FL 33912-4303
(239) 343-1700
(239) 343-1743
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-1700
(239) 343-1743
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9115630
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129100200
—
FL
Enumeration date
02/07/2022
Last updated
12/10/2025
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