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General NPI Number Information
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NPI Number | 1487122297
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Entity Type | Individual
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Provider Name | KELLE CHRISTINE DEGROAT APRN
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Gender | Female
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 1818 SHORT BRANCH DR STE 102
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City | TRINITY
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State | FL
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Zip | 34655-4425
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Country | US
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Telephone | 727-372-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 7210 RED OAK LOOP
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-5714
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Country | US
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Telephone | 727-364-1725
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11000089
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License Number State | FL
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