Provider Demographics
NPI:1407132962
Name:ELLIS, JOYCE A (C-CPT)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:ELLIS
Suffix:
Gender:F
Credentials:C-CPT
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:A
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-0034
Mailing Address - Country:US
Mailing Address - Phone:352-529-0600
Mailing Address - Fax:352-529-0601
Practice Address - Street 1:219 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2657
Practice Address - Country:US
Practice Address - Phone:352-529-0600
Practice Address - Fax:352-529-0601
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography