Healthcare Provider Details

I. General information

NPI: 1659737336
Provider Name (Legal Business Name): ELLEN LORRAINE MAKRIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1ST ST N SUITE 200
JACKSONVILLE FL
32250-6945
US

IV. Provider business mailing address

333 1ST ST N SUITE 200
JACKSONVILLE FL
32250-6945
US

V. Phone/Fax

Practice location:
  • Phone: 866-581-5038
  • Fax: 888-794-5038
Mailing address:
  • Phone: 866-581-5038
  • Fax: 888-794-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 18588-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: