Individual
MRS. KELLI M. BISSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610
(352) 273-6563
Mailing address
DEPARTMENT OF PEDIATRICS, PO BOX 100296, GAINESVILLE, FL 32610-0296
(352) 273-6563
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9256044
FL
363LP0200X
Pediatric Nurse Practitioner
24166224
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003593100
—
FL
05
—
010188849
—
VA
01
—
7003733
NC ACCESS
VA
01
—
92535N
OPTIMA HEALTH
VA
01
—
96630N
OPTIMA FAMILY CARE
VA
Enumeration date
07/12/2006
Last updated
06/26/2018
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