Provider Demographics
NPI:1780015388
Name:TEIXEIRA, KELLEY SNIPES (NP-C)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:SNIPES
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 DOUGLAS AVE
Mailing Address - Street 2:STE 179
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5200
Mailing Address - Country:US
Mailing Address - Phone:407-331-5050
Mailing Address - Fax:407-331-5189
Practice Address - Street 1:817 DOUGLAS AVE
Practice Address - Street 2:STE 179
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5200
Practice Address - Country:US
Practice Address - Phone:407-331-5050
Practice Address - Fax:407-331-5189
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9221364363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health