Healthcare Provider Details

I. General information

NPI: 1629466792
Provider Name (Legal Business Name): KELLY DAVEY LORING MSN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2014
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 N DON WICKHAM DR
CLERMONT FL
34711-1923
US

IV. Provider business mailing address

110 S WOODLAND ST
WINTER GARDEN FL
34787-3546
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8827
  • Fax: 407-660-1667
Mailing address:
  • Phone: 407-905-8827
  • Fax: 407-905-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP17114
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: