Provider Demographics
NPI:1548296379
Name:MASS, ELLEN S (APN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:MASS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8430 W BROWARD BLVD
Mailing Address - Street 2:CHILDRENS MEDICAL ASSOCIATION
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2700
Mailing Address - Country:US
Mailing Address - Phone:954-722-0300
Mailing Address - Fax:954-473-8588
Practice Address - Street 1:8430 W BROWARD BLVD
Practice Address - Street 2:CHILDRENS MEDICAL ASSOCIATION
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2700
Practice Address - Country:US
Practice Address - Phone:954-722-0300
Practice Address - Fax:954-473-8588
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9351613363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22457Medicare UPIN
NJ044728Medicare ID - Type Unspecified