Healthcare Provider Details

I. General information

NPI: 1376462044
Provider Name (Legal Business Name): MITTAL KENIL KAPADIA APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SW PHEASANT WAY
LAKE CITY FL
32024-4186
US

IV. Provider business mailing address

209 SW PHEASANT WAY
LAKE CITY FL
32024-4186
US

V. Phone/Fax

Practice location:
  • Phone: 386-538-9353
  • Fax:
Mailing address:
  • Phone: 386-538-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-11049017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: