Healthcare Provider Details

I. General information

NPI: 1588092910
Provider Name (Legal Business Name): ROBYN N ELLIS APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 DAN PROCTOR DR SUITE 2100
SAINT MARYS GA
31558-3894
US

IV. Provider business mailing address

2060 DAN PROCTOR DR SUITE 2100
SAINT MARYS GA
31558-3894
US

V. Phone/Fax

Practice location:
  • Phone: 912-882-6767
  • Fax: 912-882-6411
Mailing address:
  • Phone: 912-882-6767
  • Fax: 912-882-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN184088
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: