Provider Demographics
NPI:1922402197
Name:DARDEN, KELLY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:DARDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:207 W GORE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1014
Mailing Address - Country:US
Mailing Address - Phone:407-839-8407
Mailing Address - Fax:407-839-8446
Practice Address - Street 1:207 W GORE ST STE 302
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1014
Practice Address - Country:US
Practice Address - Phone:407-839-8407
Practice Address - Fax:407-839-8446
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9314524363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014453100Medicaid
FLARNP9314524OtherMEDICAL LICENSE
FLIC221YMedicare PIN