Provider Demographics
NPI:1508516113
Name:CHOUDJA, NELLY ELLA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:ELLA
Last Name:CHOUDJA
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 1:16808 IVY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-6022
Mailing Address - Country:US
Mailing Address - Phone:614-556-5920
Mailing Address - Fax:
Practice Address - Street 1:113 SEABOARD LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8281
Practice Address - Country:US
Practice Address - Phone:404-782-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily