Individual
TANACE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10100 BAYMEADOWS RD, APT#1504, JACKSONVILLE, FL 32256-0536
(904) 654-1499
Mailing address
10100 BAYMEADOWS RD, APT#1504, JACKSONVILLE, FL 32256-0536
(904) 654-1499
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
12888
FL
224Z00000X
Occupational Therapy Assistant
3042
CA
Other
Enumeration date
06/16/2015
Last updated
06/16/2015
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