Provider Demographics
NPI:1609090299
Name:BUCHHOLZ, ELLEN PENNY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:PENNY
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 10TH AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3141
Mailing Address - Country:US
Mailing Address - Phone:561-642-1008
Mailing Address - Fax:561-802-3976
Practice Address - Street 1:1250 SOUTHWINDS DR
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1459
Practice Address - Country:US
Practice Address - Phone:561-582-5559
Practice Address - Fax:561-439-4384
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1486232363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004962400Medicaid