Healthcare Provider Details

I. General information

NPI: 1073159752
Provider Name (Legal Business Name): KC QUALITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 24TH ST
ORLANDO FL
32805-5406
US

IV. Provider business mailing address

5979 VINELAND RD STE 111
ORLANDO FL
32819-7855
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-8857
  • Fax:
Mailing address:
  • Phone: 321-246-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KETTIA CHERENFANT
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 321-246-5358