Provider Demographics
NPI:1881992030
Name:ELLIS, KOBE (KOBE ELLIS)
Entity type:Individual
Prefix:
First Name:KOBE
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:KOBE ELLIS
Other - Prefix:
Other - First Name:KOBE
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KOBE ELLIS
Mailing Address - Street 1:9283 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5584
Mailing Address - Country:US
Mailing Address - Phone:904-568-5242
Mailing Address - Fax:
Practice Address - Street 1:9283 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5584
Practice Address - Country:US
Practice Address - Phone:904-568-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment