Healthcare Provider Details

I. General information

NPI: 1568309151
Provider Name (Legal Business Name): JESSICA ROSE ELLIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 PINELLAS ST STE 400
CLEARWATER FL
33756-3356
US

IV. Provider business mailing address

707 24TH ST SW
LARGO FL
33770-2957
US

V. Phone/Fax

Practice location:
  • Phone: 727-445-1911
  • Fax: 727-445-1987
Mailing address:
  • Phone: 813-727-9510
  • Fax: 727-445-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9244603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: