Healthcare Provider Details

I. General information

NPI: 1407589237
Provider Name (Legal Business Name): KELLY A MCLEOD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CATTLEMEN RD STE 202
SARASOTA FL
34232-6058
US

IV. Provider business mailing address

943 S BENEVA RD STE 306
SARASOTA FL
34232-2499
US

V. Phone/Fax

Practice location:
  • Phone: 941-342-8892
  • Fax: 941-342-8893
Mailing address:
  • Phone: 941-955-1108
  • Fax: 941-954-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11020653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: