Healthcare Provider Details

I. General information

NPI: 1275175689
Provider Name (Legal Business Name): KAYLA MASIKA ULMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 FOREST HILL BLVD STE 150
WELLINGTON FL
33414-6111
US

IV. Provider business mailing address

1106 4TH ST
LAKE PARK FL
33403-2637
US

V. Phone/Fax

Practice location:
  • Phone: 561-287-5622
  • Fax:
Mailing address:
  • Phone: 561-331-0852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11004554
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN294164
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5021496
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: