Healthcare Provider Details

I. General information

NPI: 1639995699
Provider Name (Legal Business Name): STEPHANIE MARIE ELLIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NW 100TH AVE
PLANTATION FL
33324-7034
US

IV. Provider business mailing address

8220 SW 29TH ST
MIAMI FL
33155-2425
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-5161
  • Fax:
Mailing address:
  • Phone: 786-449-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11036590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: