MEDICARE: NANCY ELLIS RRT

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	227900000X	Registered Respiratory Therapist	RT237	FL

General Provider Information

NPI Number	:	1851815427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ELLIS RRT

Provider Business Mailing Address
First Line	:	3253 FOX SQUIRREL DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2246
Country	:	US
Telephone Number	:	904-237-5907
Fax Number	:

Provider Business Practice Location Address
First Line	:	6851 DISTRIBUTION AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2742
Country	:	US
Telephone Number	:	904-387-4481
Fax Number	:

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	07/26/2017

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