Provider Demographics
NPI:1154057982
Name:CASTAGNA, KELLY ANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:CASTAGNA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:WASSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5153 N 9TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5719
Mailing Address - Country:US
Mailing Address - Phone:850-416-2477
Mailing Address - Fax:
Practice Address - Street 1:5153 N 9TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5719
Practice Address - Country:US
Practice Address - Phone:850-416-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily