Provider Demographics
NPI:1467013466
Name:ELY, MACY (DNP, ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:ELY
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 PRUITT DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-5708
Mailing Address - Country:US
Mailing Address - Phone:850-843-2806
Mailing Address - Fax:
Practice Address - Street 1:1215 N PEACOCK AVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2117
Practice Address - Country:US
Practice Address - Phone:850-584-5087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily