Provider Demographics
NPI:1104160217
Name:BORISADE, KAYELA FAYE (ARNP)
Entity type:Individual
Prefix:
First Name:KAYELA
Middle Name:FAYE
Last Name:BORISADE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KAYELA
Other - Middle Name:FAYE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:13500 SUTTON PARK DRIVE SOUTH
Mailing Address - Street 2:SUITE 403
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5291
Mailing Address - Country:US
Mailing Address - Phone:904-493-3390
Mailing Address - Fax:904-493-3395
Practice Address - Street 1:13500 SUTTON PARK DRIVE SOUTH
Practice Address - Street 2:SUITE 403
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5291
Practice Address - Country:US
Practice Address - Phone:904-493-3390
Practice Address - Fax:904-493-3395
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9233632363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHL342ZOtherMEDICARE - INDIVIDUAL
FL9233632OtherFL ARNP LICENSE
FL45681OtherMEDICARE - GROUP