Provider Demographics
NPI:1770934127
Name:EMELLE, NNENNA
Entity type:Individual
Prefix:
First Name:NNENNA
Middle Name:
Last Name:EMELLE
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 1:1818 VAN ALLEN LOOP
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2770
Mailing Address - Country:US
Mailing Address - Phone:863-397-6581
Mailing Address - Fax:
Practice Address - Street 1:1818 VAN ALLEN LOOP
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-2770
Practice Address - Country:US
Practice Address - Phone:863-397-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9280839363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology