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General NPI Number Information
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NPI Number | 1184297103
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Entity Type | Individual
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Provider Name | KELLY DYLIK APRN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 111 N ORANGE AVE STE 800
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City | ORLANDO
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State | FL
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Zip | 32801-2381
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 12101 PALM COVE ST
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City | FORT MYERS
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State | FL
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Zip | 33913-8724
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Country | US
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Telephone | 716-829-9682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 11014256
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11014256
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License Number State | FL
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