Provider Demographics
NPI:1689911943
Name:ANZALONE, KELLI NOEL (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:NOEL
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:NOEL
Other - Last Name:HANRATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-259-8700
Practice Address - Fax:813-259-8748
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9281316363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010863800Medicaid
FLY0LU5OtherBLUE CROSS BLUE SHIELD
FLY0LU5OtherBLUE CROSS BLUE SHIELD