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General NPI Number Information
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NPI Number | 1235657552
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Entity Type | Individual
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Provider Name | KELLY ANNE WEAVER
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Gender | Female
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 18659 TAMIAMI TRL
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City | NORTH PORT
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State | FL
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Zip | 34287-7388
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Country | US
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Telephone | 941-423-5035
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Fax | 941-423-5034
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Provider Business Mailing Address
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Address Line | 2453 BEE RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34239-6304
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Country | US
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Telephone | 941-955-8076
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Fax | 941-955-0453
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN9263549
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License Number State | FL
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