Provider Demographics
NPI:1639893399
Name:ERNEST, KYLIE NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:NICOLE
Last Name:ERNEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 MILLENIA PALMS DR APT 3304
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2281
Mailing Address - Country:US
Mailing Address - Phone:859-445-5093
Mailing Address - Fax:
Practice Address - Street 1:2100 OCOEE APOPKA RD STE 210
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-9210
Practice Address - Country:US
Practice Address - Phone:407-609-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116485363A00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant