Individual
DR. KENYANITA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
12086 FORT CAROLINE RD STE 401, JACKSONVILLE, FL 32225-7640
(904) 456-9240
(904) 456-9231
Mailing address
12086 FORT CAROLINE RD STE 401, JACKSONVILLE, FL 32225-7640
(904) 456-9240
(904) 456-9231
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS16790
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106632500
—
FL
Enumeration date
05/22/2017
Last updated
03/01/2023
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