Ellis, Tara Russell

Ellis, Tara Russell is an individual health care provider with primary practice located at 2680 Elms Plantation Blvd , North Charleston SC 29406-7101. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Student, Health Care / Student in an Organized Health Care Education/Training Program. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Ellis, Tara Russell can be contacted via phone (843) 439-6181.

Contact Information

Primary practice address
2680 Elms Plantation Blvd North Charleston SC 29406-7101
Phone: (843) 439-6181
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 25495 South Carolina
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1659951739
LBN Legal business name Ellis, Tara Russell
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 12th, 2021
Last updated Jan 20th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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