Search › Florida › 363A00000X
Ellis Fort, PA-C
NPI 1497060396 · on the registry since 2010
Practice
- Address
- 502 Palmetto St
New Smyrna Beach, FL 32168 - Phone
- (386) 957-1854
- Fax
- (386) 878-4967
- Organisation at this address
- Mdpa Solutions, Inc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Licence states on file
- FL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-05-30
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida