Provider Demographics
NPI:1700800513
Name:ELY, JANICE A (APRN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:ELY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:836 PRUDENTIAL DR STE 1103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8338
Mailing Address - Country:US
Mailing Address - Phone:904-398-7654
Mailing Address - Fax:904-398-0118
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8338
Practice Address - Country:US
Practice Address - Phone:904-398-9499
Practice Address - Fax:904-398-0118
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1835312363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308966500Medicaid
FLAJ098ZMedicare PIN