Provider Demographics
NPI:1710192844
Name:ELLERBE, DAVID LOFTON (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LOFTON
Last Name:ELLERBE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1646 WINDWARD LN
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-3260
Mailing Address - Country:US
Mailing Address - Phone:904-249-3625
Mailing Address - Fax:904-733-5515
Practice Address - Street 1:6100 KENNERLY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4368
Practice Address - Country:US
Practice Address - Phone:904-733-5550
Practice Address - Fax:904-733-5515
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 1830363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical