Provider Demographics
NPI:1457853947
Name:DIEFENDERFER, KELLEY LAUREN (FNP-C, ARNP)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:LAUREN
Last Name:DIEFENDERFER
Suffix:
Gender:F
Credentials:FNP-C, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E PACKWOOD AVE APT A208
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-927-8657
Mailing Address - Fax:
Practice Address - Street 1:3000 N ORANGE AVE STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7613
Practice Address - Country:US
Practice Address - Phone:407-896-9660
Practice Address - Fax:407-896-9661
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9253190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily