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General NPI Number Information
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NPI Number | 1144228685
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Entity Type | Individual
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Provider Name | DAVID J ELLINGSON P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 3310 WATERMAN WAY
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City | TAVARES
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State | FL
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Zip | 32778-5250
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Country | US
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Telephone | 352-343-1216
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Fax | 352-343-1582
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Provider Business Mailing Address
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Address Line | PO BOX 935921
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City | ATLANTA
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State | GA
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Zip | 31193-5921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9102690
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License Number State | FL
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