Provider Demographics
NPI:1013287754
Name:CORDOVANO, KELLIE DEE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:DEE
Last Name:CORDOVANO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4749 SOUTH ORANGE AVE.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-859-7239
Mailing Address - Fax:407-850-9185
Practice Address - Street 1:4749 SOUTH ORANGE AVE.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-859-7239
Practice Address - Fax:407-850-9185
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9241163363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics