Provider Demographics
NPI:1255138897
Name:PACK, KAMEKO REI (APRN)
Entity type:Individual
Prefix:
First Name:KAMEKO
Middle Name:REI
Last Name:PACK
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:KAMEKO
Other - Middle Name:REI
Other - Last Name:FELIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2973 ETOWAH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2002
Mailing Address - Country:US
Mailing Address - Phone:785-342-0207
Mailing Address - Fax:
Practice Address - Street 1:307 SW 14TH ST STE A
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6523
Practice Address - Country:US
Practice Address - Phone:352-877-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9609184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily