Provider Demographics
NPI:1497209811
Name:KELLY, ERIKA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11131 EVERBLADES PKWY APT 211
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9549
Mailing Address - Country:US
Mailing Address - Phone:419-343-9548
Mailing Address - Fax:
Practice Address - Street 1:8010 SUMMERLIN LAKES DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1849
Practice Address - Country:US
Practice Address - Phone:239-939-1767
Practice Address - Fax:239-939-5895
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9425265363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health