Individual
DENISE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGAC-NP-BC
Contact information
Practice address
258 S CHICKASAW TRL STE 202, ORLANDO, FL 32825-3501
(407) 303-6865
(407) 303-6537
Mailing address
1918 58TH ST S, GULFPORT, FL 33707-4802
(720) 291-3226
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN11019533
FL
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN11019533
FL
Other
Enumeration date
02/13/2019
Last updated
10/31/2023
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