Provider Demographics
NPI:1942202148
Name:VERBAL, KELLY DAWN (ARNP, CRNA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DAWN
Last Name:VERBAL
Suffix:
Gender:F
Credentials:ARNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:851 TRAFALGAR COURT
Practice Address - Street 2:SUITE 200 E
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:321-422-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3411832174400000X
FL3411832367500000X
MARN-TEMP7405367500000X
FLAPRN3411832367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306836300Medicaid
FLQ32415Medicare UPIN
FLU4050ZMedicare ID - Type Unspecified