Provider Demographics
NPI:1003152422
Name:ARTIS, ELLAMAY
Entity Type:Individual
Prefix:
First Name:ELLAMAY
Middle Name:
Last Name:ARTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 JAYBEE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-5455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 RAYMOND STREET
Practice Address - Street 2:BLDG 510
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:33897
Practice Address - Country:US
Practice Address - Phone:321-397-6764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator