Healthcare Provider Details

I. General information

NPI: 1477489045
Provider Name (Legal Business Name): ELLA YAIPEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SOUTHSIDE BLVD UNIT 900
JACKSONVILLE FL
32256-0793
US

IV. Provider business mailing address

13401 SUTTON PARK DR S APT 631
JACKSONVILLE FL
32224-5281
US

V. Phone/Fax

Practice location:
  • Phone: 904-732-4343
  • Fax:
Mailing address:
  • Phone: 954-955-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: