Provider Demographics
NPI:1164019352
Name:SCARLETT, ELLEN JOANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JOANN
Last Name:SCARLETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 MUDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WOODFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22580-2125
Mailing Address - Country:US
Mailing Address - Phone:540-538-8496
Mailing Address - Fax:
Practice Address - Street 1:6243 MUDVILLE RD
Practice Address - Street 2:
Practice Address - City:WOODFORD
Practice Address - State:VA
Practice Address - Zip Code:22580-2125
Practice Address - Country:US
Practice Address - Phone:540-538-8496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001180624163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse