Individual
CARMEN ELICIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
703 TAHITI DR, KISSIMMEE, FL 34758-4311
(407) 729-5388
Mailing address
703 TAHITI DR, KISSIMMEE, FL 34758-4311
(407) 729-5388
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E426110637440
DRIVERS LICENSE
FL
Enumeration date
01/09/2019
Last updated
01/09/2019
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