Individual
KELLY J. ROMANELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
293 NW PEACOCK BLVD, PORT ST LUCIE, FL 34986-2222
(772) 336-6601
(772) 446-7681
Mailing address
602 SW CABURN AVE, PORT ST LUCIE, FL 34953-7667
(812) 239-1348
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
139323
MT
363L00000X
Nurse Practitioner
APN.0991657-NP
CO
363LF0000X
Family Nurse Practitioner
71002642A
IN
363LF0000X
Family Nurse Practitioner
ARNP9302217
FL
363LP2300X
Primary Care Nurse Practitioner
Primary
11019552
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001888500
—
FL
05
—
57983216
—
CO
01
—
CV34Z
MEDICARE
FL
01
—
Y03K0
BLUESHIELD
FL
Enumeration date
09/16/2008
Last updated
06/17/2024
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