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NPI Code Detail

MEDICARE: HAILEE KVIDERA APRN

MEDICARE: HAILEE KVIDERA APRN
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11037532FL

General Provider Information

NPI Number : 1669279089
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEE KVIDERA APRN
Provider Business Mailing Address
First Line : 7231 BOX ELDER DR
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-6972
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6224 LAFAYETTE ST
Second Line :
City : NEW PORT RICHEY
State : FL
Zip : 34652-2626
Country : US
Telephone Number : 727-835-6798
Fax Number : 727-777-6884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2025
Last Update Date : 06/26/2025

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Directions to “ HAILEE KVIDERA APRN” Practice Location

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