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General NPI Number Information
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NPI Number | 1225447345
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Entity Type | Individual
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Provider Name | BRIDGET KELLY
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Gender | Female
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 7009 DR PHILLIPS BLVD STE 100
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City | ORLANDO
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State | FL
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Zip | 32819-5122
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Country | US
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Telephone | 407-218-4550
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Fax |
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Provider Business Mailing Address
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Address Line | 5680 OAK LAKE TRL
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City | OVIEDO
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State | FL
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Zip | 32765-7368
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Country | US
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Telephone | 412-608-2380
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9107290
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License Number State | FL
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