Healthcare Provider Details

I. General information

NPI: 1598305062
Provider Name (Legal Business Name): KELLI LYNNE EARLE APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4802
US

IV. Provider business mailing address

4101 13TH LN NE
SAINT PETERSBURG FL
33703-5303
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0406
  • Fax: 407-975-0407
Mailing address:
  • Phone: 727-709-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11004610
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number11004610
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number11004610
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number11004610
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11004610
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number11004610
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11004610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: