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General NPI Number Information
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NPI Number | 1639328537
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Entity Type | Individual
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Provider Name | KELLY J. ROMANELLY
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Gender | Female
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 293 NW PEACOCK BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2222
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Country | US
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Telephone | 772-336-6601
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Fax | 772-446-7681
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Provider Business Mailing Address
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Address Line | 602 SW CABURN AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-7667
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Country | US
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Telephone | 812-239-1348
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN.0991657-NP
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License Number State | CO
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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 | 139323
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71002642A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9302217
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 11019552
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License Number State | FL
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