Provider Demographics
NPI:1861642753
Name:ELLO, MARYLOU V (ARNP)
Entity Type:Individual
Prefix:
First Name:MARYLOU
Middle Name:V
Last Name:ELLO
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 1:4131 UNIVERSITY BLVD S STE 8
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4351
Mailing Address - Country:US
Mailing Address - Phone:904-733-3992
Mailing Address - Fax:904-737-4344
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4351
Practice Address - Country:US
Practice Address - Phone:904-733-3992
Practice Address - Fax:904-737-4344
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1842402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner