Healthcare Provider Details

I. General information

NPI: 1407622236
Provider Name (Legal Business Name): NITSHELL KERIN VILDOR APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5449 S SEMORAN BLVD STE 14
ORLANDO FL
32822-1778
US

IV. Provider business mailing address

5449 S SEMORAN BLVD STE 14
ORLANDO FL
32822-1778
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-8645
  • Fax:
Mailing address:
  • Phone: 407-322-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11030443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: