MEDICARE: KERRY DUPUIS FNP-C

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	ARNP3211912	FL
2	363L00000X	Nurse Practitioner	ARNP3211912	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ARNP3211912	OTHER	FL	FLORIDA LICENSE
2	1104864826	OTHER	FL	GROUP NPI
3	1730127655	OTHER	FL	MD NPI

General Provider Information

NPI Number	:	1528216934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY DUPUIS FNP-C

Provider Business Mailing Address
First Line	:	1507 S HIAWASSEE RD
Second Line	:	STE 105
City	:	ORLANDO
State	:	FL
Zip	:	32835-5706
Country	:	US
Telephone Number	:	407-445-9224
Fax Number	:	407-445-6236

Provider Business Practice Location Address
First Line	:	1507 S HIAWASSEE RD
Second Line	:	STE 105
City	:	ORLANDO
State	:	FL
Zip	:	32835-5706
Country	:	US
Telephone Number	:	407-445-9224
Fax Number	:	407-445-6236

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

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	04/28/2020

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Directions to “ KERRY DUPUIS FNP-C” Practice Location

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