Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP9241163 | FL |
NPI | 1013287754 |
---|---|
Provider Name | Mrs. Kellie Dee Cordovano |
First Address | Orlando, FL 32806-5419 |
Second Address | Orlando, FL 32806-5419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 11/01/2012 |