Individual
COREEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1430 MASON AVE, DAYTONA BEACH, FL 32117-4551
(386) 274-2000
(386) 274-2009
Mailing address
1862 SILVER FERN RD, PORT ORANGE, FL 32128-6741
(518) 409-3502
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11006345
FL
Other
Enumeration date
02/26/2020
Last updated
11/19/2024
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