1164839643 NPI number — MS. ELLEN MARY LAYTON APRN, FNP-BC

Table of content: MS. ELLEN MARY LAYTON APRN, FNP-BC (NPI 1164839643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164839643 NPI number — MS. ELLEN MARY LAYTON APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAYTON
Provider First Name:
ELLEN
Provider Middle Name:
MARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLARKEY
Provider Other First Name:
ELLEN
Provider Other Middle Name:
LAYTON
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164839643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 W IDLEWILD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-521-0958
Provider Business Mailing Address Fax Number:
727-867-6795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DR. TRACI'S HOUSE
Provider Second Line Business Practice Location Address:
904 E HENRY AVE
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-510-5105
Provider Business Practice Location Address Fax Number:
727-867-6795
Provider Enumeration Date:
07/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP9307092 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN9307092 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013390200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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