Healthcare Provider Details

I. General information

NPI: 1093676314
Provider Name (Legal Business Name): MEDICSPOT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 KYLAR DR NW
PALM BAY FL
32907-6825
US

IV. Provider business mailing address

2909 W NEW HAVEN AVE STE A SUITE A #407
WEST MELBOURNE FL
32904-3661
US

V. Phone/Fax

Practice location:
  • Phone: 321-462-9868
  • Fax:
Mailing address:
  • Phone: 321-462-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TALPHINETA KELLY
Title or Position: NP/ PROVIDER
Credential: FNP-BC
Phone: 321-462-9868