Provider Demographics
NPI:1588652820
Name:VONDRUKA, ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:VONDRUKA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 W CYPRESS ST
Mailing Address - Street 2:B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-7004
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:5840 W CYPRESS ST
Practice Address - Street 2:B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-7004
Practice Address - Country:US
Practice Address - Phone:813-286-0033
Practice Address - Fax:813-282-1806
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1499152363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4323WMedicare ID - Type Unspecified
FLR29144Medicare UPIN