Provider Demographics
NPI:1265965008
Name:ELLNER, DAVID CHARLES (RN, BCEN, CVRN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:ELLNER
Suffix:
Gender:M
Credentials:RN, BCEN, CVRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BELEM ST
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5203
Mailing Address - Country:US
Mailing Address - Phone:941-626-0960
Mailing Address - Fax:209-653-0960
Practice Address - Street 1:206 2ND ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1000
Practice Address - Country:US
Practice Address - Phone:941-746-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-08
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMD206372146L00000X
CT96194163WE0003X
NY638056-1163WE0003X, 163WE0003X
FLRN9314202163WE0003X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic