=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992714364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELLEN PATRICIA BISHOP ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 03/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 CLEMENT ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94121-1563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-221-4810
-----------------------------------------------------
Fax | 415-750-6608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 SW ARCHER RD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32608-1135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-376-1611
-----------------------------------------------------
Fax | 352-379-4082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP3170982
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------