Healthcare Provider Details

I. General information

NPI: 1780602599
Provider Name (Legal Business Name): KATHLEEN CONBOY-ELLIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W KENNEDY BLVD
TAMPA FL
33606-1450
US

IV. Provider business mailing address

4739 SKIMMER WAY S
ST PETERSBURG FL
33711-4660
US

V. Phone/Fax

Practice location:
  • Phone: 813-253-3333
  • Fax: 813-353-3194
Mailing address:
  • Phone: 727-867-5283
  • Fax: 727-865-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP 3105812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: