Healthcare Provider Details

I. General information

NPI: 1326978131
Provider Name (Legal Business Name): BELA ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9141 CYPRESS GREEN DR STE 1
JACKSONVILLE FL
32256-2006
US

IV. Provider business mailing address

9141 CYPRESS GREEN DR STE 1
JACKSONVILLE FL
32256-2006
US

V. Phone/Fax

Practice location:
  • Phone: 904-733-7333
  • Fax:
Mailing address:
  • Phone: 904-733-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9568745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: