Healthcare Provider Details

I. General information

NPI: 1710793914
Provider Name (Legal Business Name): KYSVEL DARELSI PETERS VARGAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4945 SW 49TH PL
OCALA FL
34474-9673
US

IV. Provider business mailing address

9456 CHARLESBERG DR
TAMPA FL
33635-1637
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-9430
  • Fax: 352-237-9698
Mailing address:
  • Phone: 813-770-9781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11026355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: