Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Derek Elvin Ellis

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1720771587

Derek Elvin Ellis is a Nurse Practitioner in Lakeland, Florida. Qualified in 2022, 4 years ago. Practices with Lakeland Regional Health Systems Inc, a 503-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
4
Licensed in
FL
In the registry since
2023
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Practice location Address checks out

1324 Lakeland Hills Blvd
Lakeland, FL 33805-4543
Phone: (863) 687-1100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 11024640 (FL)

Record details

NPI number1720771587
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 30, 2023
Last updated in NPPESMay 30, 2023
Certification dateMay 30, 2023
Mailing address6604 Oakview Ter, Tampa, FL 33610-1646

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Lakeland Regional Health Systems Inc — 503 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Lakeland