Provider Demographics
NPI:1679462964
Name:BURRIS, ELLIE CHRISTINE (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:CHRISTINE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 57TH AVENUE DR W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3517
Mailing Address - Country:US
Mailing Address - Phone:727-686-7048
Mailing Address - Fax:
Practice Address - Street 1:3407 57TH AVENUE DR W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3517
Practice Address - Country:US
Practice Address - Phone:727-686-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily