Provider Demographics
NPI:1922161348
Name:BRANKLEY, ELLEN A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:A
Last Name:BRANKLEY
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:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:4612 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7101
Practice Address - Country:US
Practice Address - Phone:813-875-9000
Practice Address - Fax:813-874-3278
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1459232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01481889OtherRAILROAD MEDICARE
FL307182100Medicaid
FL307182100Medicaid
FLP01481889OtherRAILROAD MEDICARE