| Doctor Name: | DR. TATIANNA ELLSWORTH |
| NPI Number: | 1033527601 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, PNP |
| License Number: | 95001023 |
| Business Practice Address: | 200 Mercy Circle Camp Pendleton, CA - 920555191 |
| Business Phone Number: | 7607194083 |
| Business Fax Number: | |
| Mailing Address: | Po Box 555191, CAMP PENDLETON |
| State: | CA |
| Postal Code: | 920555191 |
| Phone Number: | 7607194083 |
| Fax Number: | |
| NPI Enumeration Date: | 07/28/2014 |
| NPI Last Update Date: | 07/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 95001023 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |