Provider Demographics
NPI:1679330856
Name:ELLIS, SEAN MICHAEL (APRN)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:ELLIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BISCAYNE BLVD APT 3105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1567
Mailing Address - Country:US
Mailing Address - Phone:402-203-0599
Mailing Address - Fax:
Practice Address - Street 1:900 BISCAYNE BLVD APT 3105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1567
Practice Address - Country:US
Practice Address - Phone:402-203-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031225363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care