Healthcare Provider Details

I. General information

NPI: 1720853666
Provider Name (Legal Business Name): KELSEY M GOLOTIC AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY M BEREBERICK APRN

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CLEVELAND AVE STE 811
FORT MYERS FL
33901-5817
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3800
  • Fax: 239-343-3993
Mailing address:
  • Phone: 239-343-3800
  • Fax: 239-343-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9446083
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11030613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: