Provider Demographics
NPI:1245256403
Name:MUNIZ, KELLIE MARLYN (MD)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:MARLYN
Last Name:MUNIZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:1235 PROVIDENCE BLVD STE G
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7363
Practice Address - Country:US
Practice Address - Phone:386-473-1940
Practice Address - Fax:386-473-1961
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN1284208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice