Tucker, Kelly C

Tucker, Kelly C is an individual health care provider with primary practice located at 800 N Maitland Ave Ste 101 , Maitland FL 32751-4499. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Tucker, Kelly C can be contacted via phone (407) 660-7150.

Contact Information

Primary practice address
800 N Maitland Ave Ste 101 Maitland FL 32751-4499
Phone: (407) 660-7150
Fax: (407) 660-7108
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X ARNP9199348 Florida
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X APRN9199348 Florida

Profile Details

NPI number 1790156164
LBN Legal business name Tucker, Kelly C
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2015
Last updated Oct 13th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790156164 NPPES
Florida MEDICAID 015878700

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