Healthcare Provider Details

I. General information

NPI: 1457728297
Provider Name (Legal Business Name): KRISTY HENNING KELLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTY LEIGH HENNING FNP-C

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 284
OCOEE FL
34761-3432
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 284
OCOEE FL
34761-3432
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-1570
  • Fax: 321-841-1569
Mailing address:
  • Phone: 321-841-1570
  • Fax: 321-841-1569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9321408
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9321408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: