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Individual
MRS. KELLY RAE FLORIANO
Active
Individual
MRS. KELLY RAE FLORIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003478
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0852915090
BCBS PIN NUMBER
MI
01
—
381875190
TAX IDENTIFICATION NUMBER
MI
01
—
5220024
BCBSM PIN
MI
01
—
5601003478
PHYSICIANS ASSIST LICENSE
MI
01
—
P01025991
RR MEDICARE
MI
Enumeration date
08/29/2006
Last updated
03/07/2023
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