Provider Demographics
NPI:1417953860
Name:HUSON, ELLEN M (ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:HUSON
Suffix:
Gender:F
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10739 DEERWOOD PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4839
Mailing Address - Country:US
Mailing Address - Phone:800-793-7050
Mailing Address - Fax:866-509-6155
Practice Address - Street 1:10739 DEERWOOD PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:800-793-7050
Practice Address - Fax:866-509-6155
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152847363LF0000X
FLARNP9439216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1983001Medicare PIN
ILP45139Medicare UPIN
ILIL2548001Medicare PIN
MOP45139Medicare UPIN