Provider Demographics
NPI:1356613574
Name:ELLIS, PETRINA F (APRN-BC)
Entity type:Individual
Prefix:
First Name:PETRINA
Middle Name:F
Last Name:ELLIS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 S BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3708
Practice Address - Country:US
Practice Address - Phone:914-968-4898
Practice Address - Fax:914-968-1239
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY625326163W00000X
NYF349223207R00000X, 363LF0000X
GARN253453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine