MRS. LATRESE ANN ELLIS (NPI# 1861810749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861810749 |
| Entity Type | Individual |
| Full Name | MRS. LATRESE ANN ELLIS |
| Credential | FNP |
| Practice Address |
9803 Spyglass Dr Villa Rica GA 30180-8416 |
| Practice Telephone | 7703128410 |
| Mailing Telephone | 7703128410 |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN165019 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
9803 SPYGLASS DR |
| City | VILLA RICA |
| State | GA |
| Zip Code | 30180-8416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174161624 | Crucible Communication Therapy LLC | Speech-Language Pathologist | 9765 Walnut Grove Trail, Villa Rica, GA 30180 | 2019-12-16 |
| 1366802845 | Medic-pearl, LLC | Ambulance | 1108 Charter Oak Ct, Villa Rica, GA 30180 | 2016-02-26 |
| 1396138368 | Josette Etienne | Nurse Practitioner | 403 Permian Way Suite A, Villa Rica, GA 30180 | 2015-03-13 |
| 1447690516 | Judith L.m. Thigpen | Nurse Practitioner | 736 Highway 78 West, Minute Clinic, Villa Rica, GA 30180 | 2013-07-03 |
| 1477890168 | Wesley Douglas Mckenzie | Pharmacist | 2500 Mirror Lake Blvd, Villa Rica, GA 30180 | 2013-01-15 |
| 1497005359 | Malika Remie Rajendra | Optometrist | 600 Hwy 61, Villa Rica, GA 30180 | 2012-09-18 |
| 1972876449 | Catherine Elaine Tyson | Pharmacist | 601 Dallas Road, Villa Rica, GA 30180 | 2012-02-14 |
| 1619262433 | Villa Rica Rx LLC | Pharmacy | 222 West Wilson Street, Villa Rica, GA 30180 | 2011-06-09 |
| 1851602874 | Jules Chopin Sybert | Nurse Practitioner | 736 W. Bankhead Hwy, Villa Rica, GA 30180 | 2010-06-24 |
| 1487984019 | Lisa Wood | Occupational Therapy Assistant | 1207 Woods Walk, Villa Rica, GA 30180 | 2010-01-04 |
| Find all providers in zip 30180 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518518810 | Np At Your Convenience, LLC | Nurse Practitioner | 594 Carrollton Villa Rica Hwy # 1018, Villa Rica, GA 30180-4980 | 2019-09-27 |
| 1255819603 | Sheryl Ann Dixon | Nurse Practitioner | 2535 Grayton Loop, Villa Rica, GA 30180-6703 | 2018-07-29 |
| 1619478013 | Chrisyana Gedmyr Medcare LLC | Nurse Practitioner | 403 Permian Way Ste A, Villa Rica, GA 30180-3226 | 2018-02-22 |
| 1952834889 | Rhonda Hughley-hall | Nurse Practitioner | 30 Aberfoyle Way, Villa Rica, GA 30180-3819 | 2017-04-07 |
| 1376936369 | Tiffany Corn Henley | Nurse Practitioner | 154 Templeton Ln, Villa Rica, GA 30180-3620 | 2015-03-15 |
| 1396138368 | Josette Etienne | Nurse Practitioner | 403 Permian Way Suite A, Villa Rica, GA 30180 | 2015-03-13 |
| 1194124677 | Steven Releford | Nurse Practitioner | 262 Industrial Blvd, Villa Rica, GA 30180-1511 | 2014-08-20 |
| 1447690516 | Judith L.m. Thigpen | Nurse Practitioner | 736 Highway 78 West, Minute Clinic, Villa Rica, GA 30180 | 2013-07-03 |
| 1154660801 | Alisha Michelle Schuchman | Nurse Practitioner | 32 Wood Cir, Villa Rica, GA 30180-7446 | 2013-01-31 |
| 1538450598 | Kimberly Luann Webb Driver | Nurse Practitioner | 736 W Bankhead Hwy, Villa Rica, GA 30180-1501 | 2011-04-26 |
| Find all providers in VILLA RICA | ||||
| City | VILLA RICA |
| Zip Code | 30180 |
Please comment or provide details below to improve the information on MRS. LATRESE ANN ELLIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.