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General NPI Number Information
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NPI Number | 1669279089
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Entity Type | Individual
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Provider Name | HAILEE KVIDERA APRN
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Gender | Female
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 6224 LAFAYETTE ST
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-2626
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Country | US
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Telephone | 727-835-6798
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Fax | 727-777-6884
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Provider Business Mailing Address
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Address Line | 7231 BOX ELDER DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-6972
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11037532
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License Number State | FL
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