Provider Demographics
NPI:1376325472
Name:ANGELIDIS, KELLEY DAWN (FNP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:DAWN
Last Name:ANGELIDIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2817
Mailing Address - Country:US
Mailing Address - Phone:407-877-8080
Mailing Address - Fax:407-877-0907
Practice Address - Street 1:436 N DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2817
Practice Address - Country:US
Practice Address - Phone:407-877-8080
Practice Address - Fax:407-877-0907
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028682363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily