MEDICARE: KAYELA FAYE BORISADE ARNP

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	ARNP9233632	FL
2	363L00000X	Nurse Practitioner	ARNP9233632	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HL342Z	OTHER	FL	MEDICARE - INDIVIDUAL
3	45681	OTHER	FL	MEDICARE - GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	9233632	OTHER	FL	FL ARNP LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104160217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYELA FAYE BORISADE ARNP

Provider Business Mailing Address
First Line	:	13500 SUTTON PARK DRIVE SOUTH
Second Line	:	SUITE 403
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5291
Country	:	US
Telephone Number	:	904-493-3390
Fax Number	:	904-493-3395

Provider Business Practice Location Address
First Line	:	13500 SUTTON PARK DRIVE SOUTH
Second Line	:	SUITE 403
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5291
Country	:	US
Telephone Number	:	904-493-3390
Fax Number	:	904-493-3395

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	06/06/2024

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