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General NPI Number Information
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NPI Number | 1487645578
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Entity Type | Individual
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Provider Name | ELLEN NADINE THOMAS ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/29/2005
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 6879 SOUTHPOINT DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6179
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Country | US
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Telephone | 904-296-2441
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Fax | 904-821-3113
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Provider Business Mailing Address
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Address Line | PO BOX 16568
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City | JACKSONVILLE
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State | FL
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Zip | 32245-6568
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Country | US
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Telephone | 904-472-2300
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Fax | 904-472-2330
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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 | ARNP1763212
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License Number State | FL
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