Healthcare Provider Details

I. General information

NPI: 1841294709
Provider Name (Legal Business Name): VENDA KELLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 TAMIAMI TRL STE A
PORT CHARLOTTE FL
33952-3922
US

IV. Provider business mailing address

3434 HANCOCK BRIDGE PKWY STE. 301
NORTH FORT MYERS FL
33903-7094
US

V. Phone/Fax

Practice location:
  • Phone: 877-856-3774
  • Fax: 239-599-2612
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9429926
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3672P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: