DEREK ELVIN ELLIS

LAKELAND, FL
NPI1720771587
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: FL  11024640)
Enumeration Date2023-05-30
Last Update Date2023-05-30
Business Address
DEREK ELVIN ELLIS
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805-4543
Phone number: 863-687-1100
Mailing Address
DEREK ELVIN ELLIS
6604 OAKVIEW TER
TAMPA, FL 33610-1646
Phone number: 813-500-2455
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