Healthcare Provider Details

I. General information

NPI: 1245537034
Provider Name (Legal Business Name): JESSIE L ELLIS-JAMISON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE 32ND AVE
OCALA FL
34471-5532
US

IV. Provider business mailing address

345 W MADISON ST
STARKE FL
32091-3923
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-6599
  • Fax:
Mailing address:
  • Phone: 352-732-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN060931-APO06304
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9360848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: