Individual
MS. TINA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
7321 EASTOVER BLVD, OLIVE BRANCH, MS 38654-1413
(813) 716-7611
Mailing address
7321 EASTOVER BLVD, OLIVE BRANCH, MS 38654-1413
(813) 716-7611
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F03200290
MS
Other
Enumeration date
06/17/2021
Last updated
10/25/2022
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