Provider Demographics
NPI:1447534086
Name:KENNETT, ELIZIANE NASCIMENTO (LAC)
Entity type:Individual
Prefix:
First Name:ELIZIANE
Middle Name:NASCIMENTO
Last Name:KENNETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ELIZIANE
Other - Middle Name:LARSEN DO
Other - Last Name:NASCIMENTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1009 SE 10TH CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-7008
Mailing Address - Country:US
Mailing Address - Phone:305-332-4244
Mailing Address - Fax:
Practice Address - Street 1:1009 SE 10TH CT
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7008
Practice Address - Country:US
Practice Address - Phone:305-332-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist