Provider Demographics
NPI:1023636586
Name:LAFOND, KELLY MARIE (RN, APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:LAFOND
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 WEBB DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837
Mailing Address - Country:US
Mailing Address - Phone:863-422-0020
Mailing Address - Fax:863-422-0021
Practice Address - Street 1:141 WEBB DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:863-422-0020
Practice Address - Fax:863-422-0021
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily