Healthcare Provider Details

I. General information

NPI: 1457328734
Provider Name (Legal Business Name): HORACE A ELLIS M.S.N., A. R. N. P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVE
MIAMI FL
33136-1409
US

IV. Provider business mailing address

10246 SW 24TH CT
MIRAMAR FL
33025-6504
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-7228
  • Fax: 305-355-8091
Mailing address:
  • Phone: 954-435-3696
  • Fax: 305-355-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2180612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: