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NPI Code Detail

MEDICARE: KELLY S. DEMELE APRN-C

MEDICARE: KELLY S. DEMELE APRN-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
1363LF0000XFamily Nurse Practitioner0024175383VA
2363LF0000XFamily Nurse PractitionerA177745IA
3363LF0000XFamily Nurse Practitioner4704335452MI
4363LF0000XFamily Nurse Practitioner60769944WA
5363LF0000XFamily Nurse Practitioner9190390FL

Other Identifiers

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

General Provider Information

NPI Number : 1558451781
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY S. DEMELE APRN-C
Provider Business Mailing Address
First Line : 333 1ST ST STE A
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94105-2661
Country : US
Telephone Number : 888-033-3708
Fax Number : 888-803-3331
Provider Business Practice Location Address
First Line : 400 N TAMPA ST FL 15
Second Line :
City : TAMPA
State : FL
Zip : 33602-4730
Country : US
Telephone Number : 888-033-3708
Fax Number : 888-803-3331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 03/19/2025

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