Healthcare Provider Details

I. General information

NPI: 1588652820
Provider Name (Legal Business Name): ELLEN VONDRUKA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5840 W CYPRESS ST B
TAMPA FL
33607-7004
US

IV. Provider business mailing address

5840 W CYPRESS ST B
TAMPA FL
33607-7004
US

V. Phone/Fax

Practice location:
  • Phone: 813-286-0033
  • Fax: 813-282-1806
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP1499152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: