Provider Demographics
NPI:1801571062
Name:PIMENTEL, KEILA NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:NICOLE
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MAITLAND CENTER PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7442
Mailing Address - Country:US
Mailing Address - Phone:407-442-6048
Mailing Address - Fax:407-426-4820
Practice Address - Street 1:2400 MAITLAND CENTER PKWY STE 310
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7442
Practice Address - Country:US
Practice Address - Phone:407-426-4800
Practice Address - Fax:407-426-4820
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027007363LF0000X
FL9447393363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily