MEDICARE: ELLEN S MASS APN

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
1	363LP0200X	Pediatric Nurse Practitioner	9351613	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548296379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN S MASS APN

Provider Business Mailing Address
First Line	:	8430 W BROWARD BLVD
Second Line	:	CHILDRENS MEDICAL ASSOCIATION
City	:	PLANTATION
State	:	FL
Zip	:	33324-2700
Country	:	US
Telephone Number	:	954-722-0300
Fax Number	:	954-473-8588

Provider Business Practice Location Address
First Line	:	8430 W BROWARD BLVD
Second Line	:	CHILDRENS MEDICAL ASSOCIATION
City	:	PLANTATION
State	:	FL
Zip	:	33324-2700
Country	:	US
Telephone Number	:	954-722-0300
Fax Number	:	954-473-8588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	03/31/2015

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Directions to “ ELLEN S MASS APN” Practice Location

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