MEDICARE: KELLY LYNN RAUCH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP4811	AZ
2	363LF0000X	Family Nurse Practitioner	APRN11036937	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013256338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNN RAUCH FNP

Provider Business Mailing Address
First Line	:	27810 SUMMERGATE BLVD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6919
Country	:	US
Telephone Number	:	813-388-2948
Fax Number	:	813-388-6827

Provider Business Practice Location Address
First Line	:	325 CLYDE MORRIS BLVD STE 400
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8185
Country	:	US
Telephone Number	:	386-671-0600
Fax Number	:	386-677-9710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/21/2025

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