Provider Demographics
NPI:1659660199
Name:ELLIS, VICTORIA DENISE (CNA,HHA)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:DENISE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CNA,HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 NW 4TH BLVD
Mailing Address - Street 2:SUITE 82
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1600
Mailing Address - Country:US
Mailing Address - Phone:352-514-3561
Mailing Address - Fax:352-331-2815
Practice Address - Street 1:7257 NW 4TH BLVD
Practice Address - Street 2:SUITE 82
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1600
Practice Address - Country:US
Practice Address - Phone:352-514-3561
Practice Address - Fax:352-331-2815
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 209113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist