Provider Demographics
NPI:1780985796
Name:RENTZ, ELLEN ELAINE
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ELAINE
Last Name:RENTZ
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 1:4730 HICKORY STREAM LN FL 33860
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-7914
Mailing Address - Country:US
Mailing Address - Phone:863-640-8413
Mailing Address - Fax:863-425-1411
Practice Address - Street 1:4730 HICKORY STREAM LN FL 33860
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-7914
Practice Address - Country:US
Practice Address - Phone:863-640-8413
Practice Address - Fax:863-425-1411
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker