Provider Demographics
NPI:1801876065
Name:ELLIS, BARBARA K (ARNP-C)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:K
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CRYSTAL RIVER WOMENS HEALTH CENTER
Mailing Address - Street 2:6151 N SUNCOAST BLVD STE 1 C
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428
Mailing Address - Country:US
Mailing Address - Phone:352-794-0878
Mailing Address - Fax:352-794-0877
Practice Address - Street 1:CRYSTAL RIVER WOMENS HEALTH CENTER
Practice Address - Street 2:6151 N SUNCOAST BLVD STE 1C
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428
Practice Address - Country:US
Practice Address - Phone:352-794-0878
Practice Address - Fax:352-794-0877
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1509042363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0493WMedicare PIN