Provider Demographics
NPI:1447735014
Name:SPENCER, ELITSA (RN IBCLC)
Entity type:Individual
Prefix:
First Name:ELITSA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3494 COQUINA KEY DR SE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4114
Mailing Address - Country:US
Mailing Address - Phone:813-260-8370
Mailing Address - Fax:
Practice Address - Street 1:3494 COQUINA KEY DR SE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-4114
Practice Address - Country:US
Practice Address - Phone:813-260-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9285119163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant