Individual
ELIZABETH GRACE DOELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, EMT-B
Contact information
Practice address
5650 BOLLETTIERI BLVD, BRADENTON, FL 34210-2211
(800) 872-6425
Mailing address
3912 41ST ST W, BRADENTON, FL 34205-2327
(571) 232-8463
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000053256
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000053256
CERTIFIED ATHLETIC TRAINER
—
01
—
B202000367
EMT
VA
Enumeration date
02/07/2022
Last updated
12/15/2025
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