Active NPI
Deirdre Woolsey Ellis, PA
- Physician Assistant
- Port Canaveral, FL
National Provider Identifier
1609945179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9112912
- Practice address
- 8600 Astronaut Blvd
Port Canaveral, FL 32920-4306 - Phone
- (703) 261-1100
- NPI assigned
- Nov 7, 2006
- Last updated
- May 19, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9112912 | FL | Primary |
Addresses
Primary practice location
8600 Astronaut Blvd
Port Canaveral, FL 32920-4306
Mailing address
1366 44TH St
Sarasota, FL 34234-4628
Phone (703) 929-4983
Other names 1
- Deirdre Lynne Woolsey
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA, FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| VMD Primary Providers Central Florida PLLC | Current | Accepting new patients | |
| VMD Primary Providers Central Florida PLLC | Past | Accepting new patients |
Locations
1110 Tamiami Trl N
Nokomis, FL 34275
Interoperability endpoints
- deirdre.ellis.1@17280.direct.athenahealth.com
Organizations & group practices 6
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.
-
- Federally Qualified Health Center (FQHC)
- Sarasota, FL
- NPI 1104316272
-
- Urgent Care Clinic/Center
- Venice, FL
- NPI 1457701369
-
- Geriatric Medicine (Internal Medicine) Physician
- Sarasota, FL
- NPI 1316587926
-
- Family Medicine Physician
- Saint Cloud, FL
- NPI 1134738974
-
- Family Medicine Physician
- Nokomis, FL
- NPI 1396488664
-
- Family Medicine Physician
- Clermont, FL
- NPI 1780342618
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779148800000",
"number": "1609945179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1366 44TH ST",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342344628",
"telephone_number": "703-929-4983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8600 ASTRONAUT BLVD",
"city": "PORT CANAVERAL",
"state": "FL",
"postal_code": "329204306",
"telephone_number": "703-261-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "DEIRDRE",
"middle_name": "WOOLSEY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-07",
"last_updated": "2026-05-19",
"certification_date": "2026-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9112912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DEIRDRE",
"last_name": "WOOLSEY",
"middle_name": "LYNNE",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Port Canaveral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2026; 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.