Healthcare Provider Details

I. General information

NPI: 1487122297
Provider Name (Legal Business Name): KELLE CHRISTINE DEGROAT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 SHORT BRANCH DR STE 102
TRINITY FL
34655-4425
US

IV. Provider business mailing address

7210 RED OAK LOOP
NEW PORT RICHEY FL
34654-5714
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-4500
  • Fax:
Mailing address:
  • Phone: 727-364-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: