Healthcare Provider Details

I. General information

NPI: 1700829827
Provider Name (Legal Business Name): ELLEN ANDREWS OVSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CORPORATE SQ BLVD
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

1900 CORPORATE SQ BLVD
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-855-4364
  • Fax: 904-661-3757
Mailing address:
  • Phone: 904-855-4364
  • Fax: 904-661-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME133564
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number4183
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number18338
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: