Provider Demographics
NPI:1811976822
Name:VORBECK, ELLEN D (DNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:D
Last Name:VORBECK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-278-3662
Mailing Address - Fax:
Practice Address - Street 1:7720 US HIGHWAY 98 W
Practice Address - Street 2:STE 140
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7230
Practice Address - Country:US
Practice Address - Phone:850-278-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9407298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0156549-00Medicaid
0404807OtherMEDICA MN
500026691OtherRR MEDICARE
P66026Medicare UPIN
2227441OtherAMERICAS PPO MN
410849339 56001 C193OtherCHAMPUS
MN500002104Medicare ID - Type Unspecified
MN118808900Medicaid
1595511OtherUCARE MN
376S2VOOtherBCBS MN
NA2951031916OtherPREFERRED ONE MN