Bethany Laquell Ellis, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11007347 Issued in FL

Practice address

1001 N Federal Hwy Ste 341
Hallandale Beach, FL 33009-2404

Phone

(754) 444-9173

Fax

(786) 221-3179

NPI assigned

Jun 3, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Bethany Laquell Ellis Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Swallowing Diagnostics Inc

  • Internal Medicine Physician
  • Parkland, FL
  • NPI 1710954672
  Medicare reassignment NPD
• Ellis Home Care Agency, Corp

  • Community Health Nurse Practitioner
  • Hallandale Beach, FL
  • NPI 1780414896
  NPD Authorized official
• Conciergenp

  • Primary Care Nurse Practitioner
  • Hallandale Beach, FL
  • NPI 1760096135
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1194349308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 N FEDERAL HWY STE 341",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330092404",
            "telephone_number": "754-444-9173",
            "fax_number": "786-221-3179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 N FEDERAL HWY STE 341",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330092404",
            "telephone_number": "754-444-9173",
            "fax_number": "786-221-3179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BETHANY",
        "middle_name": "LAQUELL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-03",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11007347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETHANY",
            "last_name": "ELLIS",
            "middle_name": "LAQUELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elite Health and Wellness Clinic
• Aaron Elkin, M.D.
• Ahmed Elkoussa
• Elliott B Weinger MD PA
• Ellis Home Care Agency, Corp
• Laurie Ellis, P.A.-C.
• Emilio Castaneda MD PLLC
• Emk Psychological Services LLC
• En Love,LLC (Enlove Wellness LLC)
• Entertainment and Sports Chiropractic Medicine

• Family Nurse Practitioner in Hallandale Beach, FL
• Providers in Hallandale Beach, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.