Provider Demographics
NPI:1649606500
Name:SHERWOOD, KELLEY E (ARNP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:E
Last Name:SHERWOOD
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 1:213 S DILLARD ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3522
Mailing Address - Country:US
Mailing Address - Phone:407-614-1644
Mailing Address - Fax:407-614-1635
Practice Address - Street 1:213 S DILLARD ST
Practice Address - Street 2:SUITE 240
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3522
Practice Address - Country:US
Practice Address - Phone:407-614-1644
Practice Address - Fax:407-614-1635
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9186304363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHP025ZMedicare PIN