Provider Demographics
NPI:1104322213
Name:ELLIS, NICOLE DONA-MARIA (ARNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DONA-MARIA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DONA-MARIA
Other - Last Name:BRAMWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:18811 ANNELIS DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4452
Mailing Address - Country:US
Mailing Address - Phone:813-957-6254
Mailing Address - Fax:
Practice Address - Street 1:18811 ANNELIS DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4452
Practice Address - Country:US
Practice Address - Phone:813-957-6254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9445344363LF0000X
TXAP144230363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner