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Individual

DEREK ELVIN ELLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4543
(863) 687-1100
Mailing address
6604 OAKVIEW TER, TAMPA, FL 33610-1646
(813) 500-2455

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11024640
FL

Other

Enumeration date
05/30/2023
Last updated
05/30/2023
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