MEDICARE: MRS. KEILA INES PREWITT 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	11033358	FL

General Provider Information

NPI Number	:	1578306171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEILA INES PREWITT ARNP

Provider Business Mailing Address
First Line	:	6700 49TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-2914
Country	:	US
Telephone Number	:	727-504-7536
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 49TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-2914
Country	:	US
Telephone Number	:	727-504-7536
Fax Number	:

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

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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