Healthcare Provider Details

I. General information

NPI: 1750248746
Provider Name (Legal Business Name): KELLI JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

13518 TOPAZ LAKE CT
ORLANDO FL
32828-7467
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7856
  • Fax: 321-841-7856
Mailing address:
  • Phone: 321-841-7856
  • Fax: 321-843-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN9507315
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberRN9507315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: