Provider Demographics
NPI:1659948198
Name:SERRATO, KELLIE ANNETTE (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANNETTE
Last Name:SERRATO
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 PRADO ST
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32320-1857
Mailing Address - Country:US
Mailing Address - Phone:850-323-1016
Mailing Address - Fax:
Practice Address - Street 1:257 PRADO ST
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-1857
Practice Address - Country:US
Practice Address - Phone:850-323-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily