Healthcare Provider Details

I. General information

NPI: 1013256338
Provider Name (Legal Business Name): KELLY LYNN RAUCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CLYDE MORRIS BLVD STE 400
ORMOND BEACH FL
32174-8185
US

IV. Provider business mailing address

27810 SUMMERGATE BLVD
WESLEY CHAPEL FL
33544-6919
US

V. Phone/Fax

Practice location:
  • Phone: 386-671-0600
  • Fax: 386-677-9710
Mailing address:
  • Phone: 813-388-2948
  • Fax: 813-388-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4811
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11036937
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: