Healthcare Provider Details

I. General information

NPI: 1538816749
Provider Name (Legal Business Name): KELSIE LEE COOK APRN, MSN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 7TH ST S STE 205
ST PETERSBURG FL
33701-4748
US

IV. Provider business mailing address

13540 MONALEE AVE
SEMINOLE FL
33776-3035
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-6234
  • Fax: 727-553-7798
Mailing address:
  • Phone: 727-439-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11018498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: