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General NPI Number Information
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NPI Number | 1750179941
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Entity Type | Individual
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Provider Name | ELLYETT AHR FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 305 MEMORIAL MEDICAL PKWY STE 501
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5170
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Country | US
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Telephone | 386-615-0900
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Fax | 386-615-0902
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Provider Business Mailing Address
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Address Line | 305 MEMORIAL MEDICAL PKWY STE 501
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5170
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Country | US
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Telephone | 386-615-0900
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Fax | 386-615-0902
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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 | 11041207
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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 | 159180
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License Number State | IA
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