Healthcare Provider Details

I. General information

NPI: 1801326608
Provider Name (Legal Business Name): KACY-ANN CORDIEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ROCKLEDGE BLVD
ROCKLEDGE FL
32955-2846
US

IV. Provider business mailing address

1400 ROCKLEDGE BLVD
ROCKLEDGE FL
32955-2846
US

V. Phone/Fax

Practice location:
  • Phone: 321-735-8960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11044686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: