Provider Demographics
NPI:1861414930
Name:HUNTER, ELIZABETH T (MD,PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S ORLANDO AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5543
Mailing Address - Country:US
Mailing Address - Phone:407-740-6050
Mailing Address - Fax:407-740-0588
Practice Address - Street 1:1400 S ORLANDO AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5543
Practice Address - Country:US
Practice Address - Phone:407-740-6050
Practice Address - Fax:407-740-0588
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0046160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47754OtherBCBS
FL0619574-00Medicaid
FL47754OtherBCBS
FL0619574-00Medicaid