Provider Demographics
NPI:1346635901
Name:WESOLOWSKI, KELLY A (CRNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:WESOLOWSKI
Suffix:
Gender:F
Credentials:CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 PORTER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8915
Mailing Address - Country:US
Mailing Address - Phone:407-614-8320
Mailing Address - Fax:407-614-8323
Practice Address - Street 1:17000 PORTER RD STE 208
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8915
Practice Address - Country:US
Practice Address - Phone:407-614-8320
Practice Address - Fax:407-614-8323
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9518743163W00000X
PASP014908363LF0000X
FL11003791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse