Healthcare Provider Details

I. General information

NPI: 1346398021
Provider Name (Legal Business Name): KELLY ANN ROBERTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 ISHIE AVE
BRONSON FL
32621-6204
US

IV. Provider business mailing address

4098 LIBRA DR
ORLANDO FL
32816
US

V. Phone/Fax

Practice location:
  • Phone: 352-486-3420
  • Fax: 352-486-3421
Mailing address:
  • Phone: 407-823-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0081734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: