Individual
MRS. KATHA D ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1255 GOLFVIEW AVE, BARTOW, FL 33830-6736
(863) 519-0575
(863) 582-9251
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559
(863) 519-0575
(863) 582-9251
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN731232
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016655800
—
FL
Enumeration date
02/02/2016
Last updated
03/19/2020
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