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General NPI Number Information
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NPI Number | 1699385344
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Entity Type | Individual
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Provider Name | TAMARA F ELLIS NURSE PRAACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 163 PUTNAM COUNTY BLVD
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City | EAST PALATKA
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State | FL
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Zip | 32131-6061
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Country | US
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Telephone | 386-538-1285
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Fax |
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Provider Business Mailing Address
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Address Line | 163 PUTNAM CO BLVD P.O. BOX 362
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City | EAST PALATKA
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State | FL
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Zip | 32131-4006
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Country | US
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Telephone | 386-538-1285
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11010826
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9233624
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License Number State | FL
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