Healthcare Provider Details

I. General information

NPI: 1033856000
Provider Name (Legal Business Name): EMILY MICHELLE ELLIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD # DESK10
NAPLES FL
34119-3900
US

IV. Provider business mailing address

3451 PINE RIDGE RD BLDG 601
NAPLES FL
34109-3922
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-1662
  • Fax: 877-334-1886
Mailing address:
  • Phone: 239-449-3072
  • Fax: 877-334-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP654323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: