Provider Demographics
NPI:1073174512
Name:FLORENCE, KELLY DIANE (FNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DIANE
Last Name:FLORENCE
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9775 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1442
Mailing Address - Country:US
Mailing Address - Phone:513-853-9700
Mailing Address - Fax:513-852-8971
Practice Address - Street 1:9775 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1442
Practice Address - Country:US
Practice Address - Phone:513-853-9700
Practice Address - Fax:513-852-8971
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0037859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily