MEDICARE: KELLY M TRIPP ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN9496111	FL
2	363LA2200X	Adult Health Nurse Practitioner	ARNP9496111	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073025466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M TRIPP ARNP

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-432-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N US HIGHWAY 441 STE 540
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-8987
Country	:	US
Telephone Number	:	352-561-3290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	06/10/2026

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