Healthcare Provider Details

I. General information

NPI: 1467925834
Provider Name (Legal Business Name): KELLY LANDICHO PARKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TAMPA GENERAL CIR STE 240
TAMPA FL
33606-3578
US

IV. Provider business mailing address

5 TAMPA GENERAL CIR STE 240
TAMPA FL
33606-3578
US

V. Phone/Fax

Practice location:
  • Phone: 813-258-3309
  • Fax: 813-251-4454
Mailing address:
  • Phone: 813-258-3309
  • Fax: 813-251-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9228150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: