MEDICARE: KELLEY MAPLE APRN

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	APRN11004414	FL

General Provider Information

NPI Number	:	1679115653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY MAPLE APRN

Provider Business Mailing Address
First Line	:	1130 BAYVIEW DR
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-2505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 BAYVIEW DR
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-2505
Country	:	US
Telephone Number	:	954-764-8911
Fax Number	:

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

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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Directions to “ KELLEY MAPLE APRN” Practice Location

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