Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 11014256 | FL |
Y | 363L00000X | Nurse Practitioner | APRN11014256 | FL |
NPI | 1184297103 |
---|---|
Provider Name | Kelly Dylik |
First Address | Fort Myers, FL 33913-8724 |
Second Address | Fort Myers, FL 33905-7809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 03/08/2021 |