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Individual

GRETTA ELLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1865 NIGHTINGALE LN STE B, TAVARES, FL 32778-4322
(352) 508-5419
(352) 609-2519
Mailing address
1865 NIGHTINGALE LN, TAVARES, FL 32778-4360
(352) 457-1936

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
APRN9327255
FL
363L00000X
Nurse Practitioner
Primary
APRN9327255
FL
363LF0000X
Family Nurse Practitioner
9327255
FL

Other

Enumeration date
10/08/2018
Last updated
08/20/2021
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