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NPI Code Detail

MEDICARE: ELLEN STAR CRNA

MEDICARE: ELLEN STAR CRNA
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
1367500000XCertified Registered Nurse AnesthetistAPRN11033479FL

General Provider Information

NPI Number : 1497598049
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN STAR CRNA
Provider Business Mailing Address
First Line : 717 KENWOOD CIR
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-1779
Country : US
Telephone Number : 321-501-6727
Fax Number :
Provider Business Practice Location Address
First Line : 601 E ROLLINS ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1248
Country : US
Telephone Number : 407-303-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2024
Last Update Date : 03/19/2026

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Directions to “ ELLEN STAR CRNA” Practice Location

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