Provider Demographics
NPI:1831666825
Name:TEJEDA, KAYLIE (DNAP, CRNA, APRN)
Entity type:Individual
Prefix:DR
First Name:KAYLIE
Middle Name:
Last Name:TEJEDA
Suffix:
Gender:F
Credentials:DNAP, CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 MOSS PARK RD STE 204-281
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5898
Mailing Address - Country:US
Mailing Address - Phone:321-418-6017
Mailing Address - Fax:321-204-7056
Practice Address - Street 1:10524 MOSS PARK RD STE 204-281
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5898
Practice Address - Country:US
Practice Address - Phone:321-418-6017
Practice Address - Fax:321-204-7056
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA95001026367500000X
FLAPRN11022136367500000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty