Provider Demographics
NPI:1508185653
Name:SIMPSON, ELLEN TRACY (BS, IBCLC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:TRACY
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S WOODLYNNE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3013
Mailing Address - Country:US
Mailing Address - Phone:813-839-2737
Mailing Address - Fax:
Practice Address - Street 1:112 S WOODLYNNE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3013
Practice Address - Country:US
Practice Address - Phone:813-839-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN