LYNNE M. ELLIS, MD,PA
Ambulatory Health at 7 Ave, Saint Petersburg, FL

License number
Florida 46897
Category
Ambulatory Health
Type
Primary Care
Owner
Name: LYNNE M ELLIS MD
Title: PRESIDENT
Phone: (727) 822-5393
Address
Address
1111 7Th Ave N STE 103, Saint Petersburg, FL 33705
National Provider ID: 1912056540
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LYNNE M. ELLIS, M.D., PA

1111 7 Ave N SUITE #103, Saint Petersburg, FL 33705

Status:
Inactive
Doing business as:
Lynne M Ellis MD PA
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Aug 31, 1994
Inactive since:
Jan 23, 1995
Phone:
(727) 822-5393 (Phone)
State ID:
P94000064345
Business type:
Florida Profit Corporation
Vice Presidents:
Md Ellis,Arnp Fine,Dc Ellis,...
Agent:
Ellis, Lynne M. Md Pa
EIN:
65-0545158

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