Healthcare Provider Details

I. General information

NPI: 1922161348
Provider Name (Legal Business Name): ELLEN A. BRANKLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 N HABANA AVE
TAMPA FL
33614-7101
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-9000
  • Fax: 813-874-3278
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1459232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: