Healthcare Provider Details

I. General information

NPI: 1801380415
Provider Name (Legal Business Name): KELSEY ANNE CIOCIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 BEXLEY VILLAGE DR # 200
LAND O LAKES FL
34638-2721
US

IV. Provider business mailing address

2435 BEXLEY VILLAGE DR # 200
LAND O LAKES FL
34638-2721
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4771
  • Fax: 813-467-4783
Mailing address:
  • Phone: 813-467-4771
  • Fax: 813-467-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: