Healthcare Provider Details

I. General information

NPI: 1720907298
Provider Name (Legal Business Name): KERI D NOONAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6091 MASTERS BVLD
ORLANDO FL
32819-8001
US

IV. Provider business mailing address

6091 MASTERS BVLD
ORLANDO FL
32819-8001
US

V. Phone/Fax

Practice location:
  • Phone: 407-325-1076
  • Fax:
Mailing address:
  • Phone: 407-325-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11048546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: