Ellis, Colette Suzanne

Ellis, Colette Suzanne is an individual health care provider with primary practice located at 1545 Hand Ave Ste A1 , Ormond Beach FL 32174. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Ellis, Colette Suzanne can be contacted via phone (386) 274-2977.

Contact Information

Primary practice address
1545 Hand Ave Ste A1 Ormond Beach FL 32174
Phone: (386) 274-2977
Fax: (386) 274-2997
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 2156 South Carolina
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X ARNP9168266 Florida

Profile Details

NPI number 1295792067
LBN Legal business name Ellis, Colette Suzanne
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 27th, 2006
Last updated Jul 11th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295792067 NPPES
Florida MEDICAID 004480400

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