Organization
ELLIS PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENYANITA ELLIS DO (OWNER/PEDIATRICIAN)
(904) 456-9240
Entity
Organization
Contact information
Practice address
12086 FORT CAROLINE RD STE 401, JACKSONVILLE, FL 32225-7640
(904) 456-9240
Mailing address
12086 FORT CAROLINE RD STE 401, JACKSONVILLE, FL 32225-7640
(904) 456-9240
(904) 456-9231
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
10/10/2022
Last updated
03/01/2023
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