Provider Demographics
NPI:1033856000
Name:ELLIS, EMILY MICHELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MICHELLE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 PINE RIDGE RD BLDG 601
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3922
Mailing Address - Country:US
Mailing Address - Phone:239-449-3072
Mailing Address - Fax:877-334-1886
Practice Address - Street 1:6101 PINE RIDGE RD # DESK10
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-649-1662
Practice Address - Fax:877-334-1886
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP654323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE420213858290OtherFLORIDA DRIVERS LICENSE