Healthcare Provider Details

I. General information

NPI: 1437376324
Provider Name (Legal Business Name): KELLIE ANN MCGUIRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLIE MCGUIRE-O'SHEA

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 BLOOMFIELD AVE
GLEN RIDGE NJ
07028-1308
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 973-743-1121
  • Fax:
Mailing address:
  • Phone: 239-343-6410
  • Fax: 239-343-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11032696
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332076
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN08534500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: