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General NPI Number Information
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NPI Number | 1417948647
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Entity Type | Individual
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Provider Name | PAMELA I ELLSWORTH M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2005
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Last Update Date | 01/13/2018
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Provider Practice Location Address
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Address Line | 13535 NEMOURS PKWY
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City | ORLANDO
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State | FL
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Zip | 32827-7402
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Country | US
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Telephone | 407-567-4000
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Fax | 407-567-5924
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Provider Business Mailing Address
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Address Line | 10140 CENTURION PKWY N
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0532
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Country | US
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Telephone | 904-697-4127
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Fax | 904-697-5102
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 150422
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | ME129642
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD11894
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 150422
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License Number State | MA
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