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General NPI Number Information
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NPI Number | 1891516993
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Entity Type | Individual
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Provider Name | KELLIE TANNOCK APRN
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1009 SW 16TH LN
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City | OCALA
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State | FL
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Zip | 34471-1228
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Country | US
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Telephone | 352-351-3413
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Fax | 352-629-6667
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Provider Business Mailing Address
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Address Line | 11240 SE 44TH AVE
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City | BELLEVIEW
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State | FL
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Zip | 34420-3721
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Country | US
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Telephone | 352-843-7366
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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 | APRN11035483
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11035483
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License Number State | FL
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