Individual
MRS. TASHIKA ELLIS-SUTTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1625 SW LA GORCE AVE, PORT ST LUCIE, FL 34953-2568
(772) 777-0624
Mailing address
1625 SW LA GORCE AVE, PORT ST LUCIE, FL 34953-2568
(772) 777-0624
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN-99566
HI
Other
Enumeration date
01/06/2021
Last updated
01/06/2021
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