Provider Demographics
NPI:1164908604
Name:HARTMANN, KELSEY TAYLOR (APRN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:TAYLOR
Last Name:HARTMANN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:TAYLOR
Other - Last Name:WILLOUGHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:240 CRANDON BLVD
Mailing Address - Street 2:STE 212
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149
Mailing Address - Country:US
Mailing Address - Phone:305-361-6232
Mailing Address - Fax:
Practice Address - Street 1:240 CRANDON BLVD
Practice Address - Street 2:STE 212
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149
Practice Address - Country:US
Practice Address - Phone:305-361-6232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9483863363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily