Provider Demographics
NPI:1861967887
Name:ELUNA ROSZELL, KINDRED MARIE CORSAME (ARNP)
Entity type:Individual
Prefix:
First Name:KINDRED
Middle Name:MARIE CORSAME
Last Name:ELUNA ROSZELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9800
Mailing Address - Fax:239-343-9848
Practice Address - Street 1:13340 METRO PKWY STE 1000
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4819
Practice Address - Country:US
Practice Address - Phone:239-343-0490
Practice Address - Fax:239-343-0499
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9284945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101316400Medicaid