Healthcare Provider Details

I. General information

NPI: 1700800513
Provider Name (Legal Business Name): JANICE A. ELY A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR SUITE 1103
JACKSONVILLE FL
32207-8338
US

IV. Provider business mailing address

836 PRUDENTIAL DR STE 1103
JACKSONVILLE FL
32207-8338
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-9499
  • Fax: 904-398-0118
Mailing address:
  • Phone: 904-398-7654
  • Fax: 904-398-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPRN1835312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: