Individual
COLETTE SUZANNE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1545 HAND AVE STE A1, ORMOND BEACH, FL 32174
(386) 274-2977
(386) 274-2997
Mailing address
1671 N CLYDE MORRIS BLVD STE 100, DAYTONA BEACH, FL 32117-5590
(386) 274-2977
(386) 274-2997
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2156
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9168266
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004480400
—
FL
Enumeration date
04/27/2006
Last updated
07/11/2018
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