Provider Demographics
NPI:1487787669
Name:KELLER, PATTI (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7394 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7802
Mailing Address - Country:US
Mailing Address - Phone:352-564-0444
Mailing Address - Fax:352-564-4222
Practice Address - Street 1:7562 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7840
Practice Address - Country:US
Practice Address - Phone:352-564-0444
Practice Address - Fax:352-564-4222
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9259474364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9259474OtherFLORIDA BOARD OF NURSING
FLHQ475ZMedicare PIN