Basic Information
| Provider Information | |||||||||
| NPI: | 1003295080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGLISH | ||||||||
| FirstName: | ELIKA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3839 COUNTY ROAD 218 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320685708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042826331 | ||||||||
| FaxNumber: | 9042824117 | ||||||||
| Practice Location | |||||||||
| Address1: | 10250 NORMANDY BLVD | ||||||||
| Address2: | STE 802 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322218059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043797155 | ||||||||
| FaxNumber: | 9043797165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2015 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND 6799 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.