Healthcare Provider Details

I. General information

NPI: 1275020968
Provider Name (Legal Business Name): ELOISA ANNE ELLO-ESMA ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W. 8TH STREET
JACKSONVILLE FL
32209
US

IV. Provider business mailing address

8313 CANDLEWOOD COVE TRL
JACKSONVILLE FL
32244-8901
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-0411
  • Fax:
Mailing address:
  • Phone: 904-887-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberARNP9223595
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9223595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: