Provider Demographics
NPI:1629502513
Name:AQUINO, ELAINE MELISSA (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MELISSA
Last Name:AQUINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MELISSA
Other - Last Name:RACERO FELIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5112 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6873
Mailing Address - Country:US
Mailing Address - Phone:813-374-2406
Mailing Address - Fax:813-374-2407
Practice Address - Street 1:5112 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6873
Practice Address - Country:US
Practice Address - Phone:813-374-2406
Practice Address - Fax:813-374-2407
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100101649Medicaid