Provider Demographics
NPI:1407627755
Name:WELLS, ELISSA (APRN)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S OCEAN LN APT 1410
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3865
Mailing Address - Country:US
Mailing Address - Phone:954-304-2003
Mailing Address - Fax:
Practice Address - Street 1:2200 S OCEAN LN APT 1410
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3865
Practice Address - Country:US
Practice Address - Phone:954-304-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAG10230083363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care