Provider Demographics
NPI:1710601828
Name:HOLBERT, KELLY RYAN (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:RYAN
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19907 WYNDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1731
Mailing Address - Country:US
Mailing Address - Phone:813-728-4414
Mailing Address - Fax:
Practice Address - Street 1:22829 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5227
Practice Address - Country:US
Practice Address - Phone:813-915-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily