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General NPI Number Information
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NPI Number | 1184859415
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Entity Type | Individual
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Provider Name | ELLEN LOUISE POTTS ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 2140 KINGSLEY AVE SUITE 2
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City | ORANGE PARK
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State | FL
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Zip | 32073
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Country | US
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Telephone | 904-886-4878
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Fax | 904-886-7438
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Provider Business Mailing Address
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Address Line | PO BOX 57967
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City | JACKSONVILLE
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State | FL
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Zip | 32241-7967
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Country | US
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Telephone | 904-886-4878
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Fax | 904-884-7438
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP668652
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License Number State | FL
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