Provider Demographics
NPI:1740460930
Name:KELSEY, JENNIFER M (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:KELSEY
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 1:807 S ORLANDO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4870
Mailing Address - Country:US
Mailing Address - Phone:407-515-2212
Mailing Address - Fax:407-539-0469
Practice Address - Street 1:4100 METRIC DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6837
Practice Address - Country:US
Practice Address - Phone:407-681-8720
Practice Address - Fax:407-681-8729
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9191787363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308888000Medicaid
FL308888000Medicaid
FL591561574OtherEIN