Provider Demographics
NPI:1235996604
Name:MADIDI, KAMALA RAJYALAKSHMI (FNP)
Entity Type:Individual
Prefix:
First Name:KAMALA
Middle Name:RAJYALAKSHMI
Last Name:MADIDI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 100TH DR E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-4413
Mailing Address - Country:US
Mailing Address - Phone:941-773-0984
Mailing Address - Fax:
Practice Address - Street 1:5110 100TH DRIVE EAST
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-3421
Practice Address - Country:US
Practice Address - Phone:941-773-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily