Provider Demographics
NPI:1063744423
Name:ELLIS, ERICA ELAIN (FNP)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:ELAIN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 LONE STAR WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8775
Mailing Address - Country:US
Mailing Address - Phone:919-672-8803
Mailing Address - Fax:
Practice Address - Street 1:1350 SE MAYNARD RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3634
Practice Address - Country:US
Practice Address - Phone:919-651-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily