MEDICARE: DR. NATALIE N ELLIS M.D.

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	207Q00000X	Family Medicine Physician	ME 108149	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14A10	OTHER	FL	BCBS OF FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ME 108149	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1770593634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE N ELLIS M.D.

Provider Business Mailing Address
First Line	:	DR. NATALIE ELLIS
Second Line	:	2520 CENTRAL AVE.
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1862
Country	:	US
Telephone Number	:	727-203-4207
Fax Number	:

Provider Business Practice Location Address
First Line	:	DR. NATALIE ELLIS
Second Line	:	2520 CENTRAL AVE.
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1862
Country	:	US
Telephone Number	:	727-203-4207
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/13/2018

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