Healthcare Provider Details

I. General information

NPI: 1528666864
Provider Name (Legal Business Name): KELSEY CHRISTINE KVARTEK APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BAYOU BLVD., SUITE 6
PENSACOLA FL
32503
US

IV. Provider business mailing address

4700 BAYOU BLVD., SUITE 6
PENSACOLA FL
32503
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-9253
  • Fax: 850-494-9843
Mailing address:
  • Phone: 850-477-9253
  • Fax: 850-494-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11008830
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11008830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: