Provider Demographics
NPI:1316975055
Name:ESSES, ELLEN JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JENNIFER
Last Name:ESSES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:JENNIFER
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:31 E MACK BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7102
Mailing Address - Country:US
Mailing Address - Phone:850-267-2292
Mailing Address - Fax:850-267-3957
Practice Address - Street 1:31 E MACK BAYOU DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7102
Practice Address - Country:US
Practice Address - Phone:850-267-2292
Practice Address - Fax:850-267-3957
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 81353207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05180OtherBCBS
FL262645400Medicaid
FL7140355OtherAETNA
FL05180ZMedicare PIN
FLH-56803Medicare UPIN