Individual
LOLITA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
206 E IOWA AVE, BONIFAY, FL 32425-2208
(850) 849-3869
(850) 547-1568
Mailing address
206 E IOWA AVE, BONIFAY, FL 32425-2208
(850) 849-3869
(850) 547-1568
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747A0650X
Attendant Care Provider
166844
FL
374U00000X
Home Health Aide
166844
FL
376J00000X
Homemaker
166844
FL
376K00000X
Nurse's Aide
Primary
166844
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
607114
ATN
FL
Enumeration date
10/16/2015
Last updated
06/27/2016
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