Provider Demographics
NPI:1538536032
Name:GIRNYS, KELLIE B (ARNP)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:B
Last Name:GIRNYS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:B
Other - Last Name:WISHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2501 N ORANGE AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4674
Mailing Address - Country:US
Mailing Address - Phone:407-303-7250
Mailing Address - Fax:407-303-7255
Practice Address - Street 1:2501 N ORANGE AVE STE 402
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4674
Practice Address - Country:US
Practice Address - Phone:407-303-7250
Practice Address - Fax:407-303-7255
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9411076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily