Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | ARNP9223595 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9223595 | FL |
NPI | 1275020968 |
---|---|
Provider Name | Eloisa Anne Ello-Esma |
First Address | Jacksonville, FL 32244-8901 |
Second Address | Jacksonville, FL 32209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 18/04/2018 |