Healthcare Provider Details

I. General information

NPI: 1710814207
Provider Name (Legal Business Name): TASIA TRICIA CAMPBELL-ELLIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8281 BERMUDA SOUND WAY
BOYNTON BEACH FL
33436-1727
US

IV. Provider business mailing address

8281 BERMUDA SOUND WAY
BOYNTON BEACH FL
33436-1727
US

V. Phone/Fax

Practice location:
  • Phone: 863-877-9913
  • Fax:
Mailing address:
  • Phone: 863-877-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: