Healthcare Provider Details

I. General information

NPI: 1790319572
Provider Name (Legal Business Name): KELLY NICOLE NICKELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY NICOLE SWISHER RN

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

62 COLUMBIA ST
ORLANDO FL
32806-1115
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8610
  • Fax: 352-273-8612
Mailing address:
  • Phone: 321-843-5851
  • Fax: 321-843-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number129422
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11007463
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: