Provider Demographics
NPI:1104280031
Name:ELLIS, ALLISON JENNY
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:JENNY
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 SW 23RD TER
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7521
Mailing Address - Country:US
Mailing Address - Phone:954-263-4678
Mailing Address - Fax:
Practice Address - Street 1:1559 SW 23RD TER
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7521
Practice Address - Country:US
Practice Address - Phone:954-263-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY449760163W00000X
FLRN3020962163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163W00000XNursing Service ProvidersRegistered Nurse