Provider Demographics
NPI:1073159752
Name:KC QUALITY CARE
Entity Type:Organization
Organization Name:KC QUALITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KETTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERENFANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-246-5358
Mailing Address - Street 1:5979 VINELAND RD STE 111
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7855
Mailing Address - Country:US
Mailing Address - Phone:321-246-5358
Mailing Address - Fax:
Practice Address - Street 1:815 24TH ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-5406
Practice Address - Country:US
Practice Address - Phone:407-704-8857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service