Individual
COLEEN ANN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 10TH ST E, PALMETTO, FL 34221-4134
(941) 847-7903
(941) 847-7919
Mailing address
1120 10TH ST E, PALMETTO, FL 34221-4134
(941) 847-7903
(941) 847-7919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME87898
FL
207R00000X
Internal Medicine Physician
ME87898
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271958400
—
FL
Enumeration date
02/16/2006
Last updated
08/16/2021
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