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NPI Code Detail

MEDICARE: CRISTIN ELLIS

MEDICARE: CRISTIN ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1013570514
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRISTIN ELLIS
Provider Business Mailing Address
First Line : 4300 SW 13TH ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32608-4006
Country : US
Telephone Number : 352-374-5600
Fax Number :
Provider Business Practice Location Address
First Line : 92 W LOWDER ST
Second Line :
City : MACCLENNY
State : FL
Zip : 32063-2676
Country : US
Telephone Number : 352-374-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2019
Last Update Date : 04/19/2019

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Directions to “ CRISTIN ELLIS ” Practice Location

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