Provider Demographics
NPI:1770339707
Name:HOECHERL, KELSIE RAE (APRN)
Entity type:Individual
Prefix:MISS
First Name:KELSIE
Middle Name:RAE
Last Name:HOECHERL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:52 UNDERWOOD ST # MP53
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:321-843-5270
Mailing Address - Fax:321-842-6419
Practice Address - Street 1:52 UNDERWOOD ST # MP53
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:321-843-5270
Practice Address - Fax:321-842-6419
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING207RC0200X
FLAPRN11032977363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122644400Medicaid