Healthcare Provider Details

I. General information

NPI: 1093148611
Provider Name (Legal Business Name): MRS. KELLY LYNN ARIOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KELLY KELLER AHMAD

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 COCOS DR
FORT MYERS FL
33908-4622
US

IV. Provider business mailing address

6323 COCOS DR
FORT MYERS FL
33908-4622
US

V. Phone/Fax

Practice location:
  • Phone: 239-200-7131
  • Fax:
Mailing address:
  • Phone: 239-200-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9286678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: