Provider Demographics
NPI:1801201926
Name:ELLERT, MICHELE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:ELLERT
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 1:710 FAIRVIEW CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-5306
Mailing Address - Country:US
Mailing Address - Phone:407-473-7545
Mailing Address - Fax:
Practice Address - Street 1:710 FAIRVIEW CHURCH RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344
Practice Address - Country:US
Practice Address - Phone:407-473-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2166292363L00000X
TNAPN0000024129363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner