Provider Demographics
NPI:1235289158
Name:ELLINGSON, KAREN L (PA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 FIVAY RD STE 340
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7181
Mailing Address - Country:US
Mailing Address - Phone:727-861-0237
Mailing Address - Fax:727-861-0278
Practice Address - Street 1:14100 FIVAY RD STE 340
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7181
Practice Address - Country:US
Practice Address - Phone:727-861-0237
Practice Address - Fax:727-861-0278
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101110208M00000X, 363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS97330Medicare UPIN
FLE5959XMedicare ID - Type Unspecified