Healthcare Provider Details

I. General information

NPI: 1598247314
Provider Name (Legal Business Name): KETSIA AURELIEN A-GNP NURSE PRACTITI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 SUN N LAKE BLVD
SEBRING FL
33872-2176
US

IV. Provider business mailing address

28 E MAIN ST UNIT 126
AVON PARK FL
33825-3943
US

V. Phone/Fax

Practice location:
  • Phone: 863-386-0055
  • Fax: 863-386-0118
Mailing address:
  • Phone: 786-459-4226
  • Fax: 458-200-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9311187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: