Healthcare Provider Details

I. General information

NPI: 1689379877
Provider Name (Legal Business Name): PRIYA KONDA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 PALM ST STE 1
COCOA FL
32927-5100
US

IV. Provider business mailing address

PO BOX 878
DAVENPORT FL
33836-0878
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-4243
  • Fax: 321-639-4266
Mailing address:
  • Phone: 689-223-3898
  • Fax: 689-223-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11025509
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: