Basic Information
Provider Information
NPI: 1184841454
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAY
FirstName: ELOISE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 131 SW 84TH TER
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326071434
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 529 NW 60TH ST
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326072008
CountryCode: US
TelephoneNumber: 3523315100
FaxNumber: 3523329607
Other Information
ProviderEnumerationDate: 04/19/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XARNP2709472FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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