Individual
TINA MARLENE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4969 CENTRE POINTE DR, STE 100, NORTH CHARLESTON, SC 29418-6952
(843) 853-0250
(843) 606-8103
Mailing address
4969 CENTRE POINTE DR, STE 100, NORTH CHARLESTON, SC 29418-6952
(843) 853-0250
(843) 606-8103
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2889
SC
363AM0700X
Medical Physician Assistant
2889
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4750017
—
AZ
Enumeration date
11/05/2009
Last updated
01/27/2022
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