Provider Demographics
NPI:1528216934
Name:DUPUIS, KERRY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5706
Mailing Address - Country:US
Mailing Address - Phone:407-445-9224
Mailing Address - Fax:407-445-6236
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:STE 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5706
Practice Address - Country:US
Practice Address - Phone:407-445-9224
Practice Address - Fax:407-445-6236
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3211912363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3211912OtherFLORIDA LICENSE
FL1104864826OtherGROUP NPI
FL1730127655OtherMD NPI