Basic Information
| Provider Information | |||||||||
| NPI: | 1609090299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCHHOLZ | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | PENNY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 10TH AVE N | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334613141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616421008 | ||||||||
| FaxNumber: | 5618023976 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 SOUTHWINDS DR | ||||||||
| Address2: | |||||||||
| City: | LANTANA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615825559 | ||||||||
| FaxNumber: | 5614394384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 02/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | ARNP 1486232 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 004962400 | 05 | FL | MEDICAID |