Individual
JORDAN LACEY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
636 DEL PRADO BLVD S, CAPE CORAL, FL 33990-2668
(888) 339-8727
Mailing address
13350 METRO PKWY STE 301, FORT MYERS, FL 33966-4796
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9445555
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11028253
FL
Other
Enumeration date
08/22/2022
Last updated
10/13/2023
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