Healthcare Provider Details

I. General information

NPI: 1942202148
Provider Name (Legal Business Name): KELLY DAWN VERBAL ARNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 TRAFALGAR COURT SUITE 200 E
MAITLAND FL
32751
US

IV. Provider business mailing address

713 ANDREWS DR
LONGWOOD FL
32750-6705
US

V. Phone/Fax

Practice location:
  • Phone: 321-422-7195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberARNP3411832
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3411832
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-TEMP7405
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN3411832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: