Healthcare Provider Details

I. General information

NPI: 1578036331
Provider Name (Legal Business Name): JODI-ANN SADE ELLISTON DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

6612 DAHLIA DR
MIRAMAR FL
33023-4911
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4400
  • Fax:
Mailing address:
  • Phone: 786-375-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9327731
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11000994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: