Individual
EMILY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
601 E ROLLINS ST, ORLANDO, FL 32803-1248
(407) 303-2528
(407) 303-2760
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-4325
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
ND6061
FL
363A00000X
Physician Assistant
PA14548
TX
363AM0700X
Medical Physician Assistant
Primary
PA9112117
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105187500
—
FL
01
—
5ILU8
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/17/2014
Last updated
07/22/2025
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