Healthcare Provider Details

I. General information

NPI: 1164908604
Provider Name (Legal Business Name): KELSEY TAYLOR HARTMANN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY TAYLOR WILLOUGHBY APRN

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CRANDON BLVD STE 212
KEY BISCAYNE FL
33149
US

IV. Provider business mailing address

240 CRANDON BLVD STE 212
KEY BISCAYNE FL
33149
US

V. Phone/Fax

Practice location:
  • Phone: 305-361-6232
  • Fax:
Mailing address:
  • Phone: 305-361-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9483863
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9483863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: