Individual
AMY JO KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1790 HIDEAWAY LN, EDGEWATER, FL 32132-2913
(386) 689-0586
Mailing address
110 W 1ST ST STE 236, SANFORD, FL 32771-1202
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F04210218
FL
Other
Enumeration date
04/07/2021
Last updated
04/07/2021
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