Healthcare Provider Details

I. General information

NPI: 1528754140
Provider Name (Legal Business Name): KELLY CARTAGENA DNP, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY KOZIOL

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT STE 104
MIAMI FL
33155-4069
US

IV. Provider business mailing address

1395 NW 122ND TER
PEMBROKE PINES FL
33026-4308
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6448
  • Fax:
Mailing address:
  • Phone: 954-444-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN9451198
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11016590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: