| Ellis Integrative Family Practice Inc | |
|
1865 Nightingale Ln Ste B Tavares FL 32778-4360 | |
| (352) 457-1936 | |
| Not Available |
| Full Name | Ellis Integrative Family Practice Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1865 Nightingale Ln Ste B, Tavares, Florida |
| Authorized Official Name and Position | Gretta Ellis (PRESIDENT) |
| Authorized Official Contact | 3524571936 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis Integrative Family Practice Inc 1865 Nightingale Ln Tavares FL 32778-4360 Ph: (352) 457-1936 | Ellis Integrative Family Practice Inc 1865 Nightingale Ln Ste B Tavares FL 32778-4360 Ph: (352) 457-1936 |
| NPI Number | 1174101562 |
|---|---|
| Provider Enumeration Date | 03/29/2021 |
| Last Update Date | 04/19/2021 |
| Medicare PECOS PAC ID | 9638578065 |
|---|---|
| Medicare Enrollment ID | O20210604000448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174101562 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gretta Michelle Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457826281 PECOS PAC ID: 3870835101 Enrollment ID: I20190507000211 |
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