Provider Demographics
NPI:1851815427
Name:ELLIS, NANCY (RRT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 FOX SQUIRREL DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2246
Mailing Address - Country:US
Mailing Address - Phone:904-237-5907
Mailing Address - Fax:
Practice Address - Street 1:6851 DISTRIBUTION AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2742
Practice Address - Country:US
Practice Address - Phone:904-387-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT237227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered