MEDICARE: MS. KELLEY LAUREN DIEFENDERFER FNP-C, 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	9253190	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

General Provider Information

NPI Number	:	1457853947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLEY LAUREN DIEFENDERFER FNP-C, ARNP

Provider Business Mailing Address
First Line	:	430 E PACKWOOD AVE APT A208
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751
Country	:	US
Telephone Number	:	407-927-8657
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 N ORANGE AVE STE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-7613
Country	:	US
Telephone Number	:	407-896-9660
Fax Number	:	407-896-9661

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

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	03/01/2018

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