Individual
JENNIFER ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
180 S CHERRY ST, SUITE F, MONTICELLO, FL 32344-1929
(850) 694-2204
(850) 997-4483
Mailing address
425 CEDAR ST, MONTICELLO, FL 32344-1529
(850) 694-2204
(850) 997-4483
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA30673
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C9973
BCBS OF FL
FL
Enumeration date
05/11/2011
Last updated
05/11/2011
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