Individual
ELENA MODEL-RYBAKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1370 13TH AVE S, STE 216, JACKSONVILLE BEACH, FL 32250-3230
(904) 246-8480
(904) 246-8578
Mailing address
1009 BITTERSWEET BRANCH CT, JACKSONVILLE, FL 32259-5261
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME92233
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28633
BCBS PROVIDER ID
FL
01
—
7682202002
CIGNA PAL ID
FL
01
—
7910755
AETNA PROVIDER ID
FL
Enumeration date
08/24/2006
Last updated
01/06/2011
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