Provider Demographics
NPI:1184867772
Name:ABELLANA, ELLEN ROSE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ROSE
Last Name:ABELLANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 KINGSLEY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4490
Mailing Address - Country:US
Mailing Address - Phone:904-215-7015
Mailing Address - Fax:
Practice Address - Street 1:2001 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5148
Practice Address - Country:US
Practice Address - Phone:904-215-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-12
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116195207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology