Provider Demographics
NPI:1164839643
Name:MULLARKEY, ELLEN LAYTON (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LAYTON
Last Name:MULLARKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:LAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-867-8641
Mailing Address - Fax:727-867-6795
Practice Address - Street 1:2812 54TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-4610
Practice Address - Country:US
Practice Address - Phone:727-867-8641
Practice Address - Fax:727-867-6795
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9307092363L00000X
FLAPRN9307092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner