Provider Demographics
NPI:1750179941
Name:AHR, ELLYETT (FNP-BC)
Entity type:Individual
Prefix:
First Name:ELLYETT
Middle Name:
Last Name:AHR
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ELLYETT
Other - Middle Name:
Other - Last Name:SAKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3626 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4226
Mailing Address - Country:US
Mailing Address - Phone:818-307-8718
Mailing Address - Fax:
Practice Address - Street 1:322 BIG TREE RD FL 32119
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2922
Practice Address - Country:US
Practice Address - Phone:386-615-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA159180163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse