Provider Demographics
NPI:1386398642
Name:GREENLAND, KERRY-ANN PATRIA
Entity type:Individual
Prefix:
First Name:KERRY-ANN
Middle Name:PATRIA
Last Name:GREENLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 NW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-1933
Mailing Address - Country:US
Mailing Address - Phone:754-244-4362
Mailing Address - Fax:
Practice Address - Street 1:206 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2344
Practice Address - Country:US
Practice Address - Phone:407-846-0023
Practice Address - Fax:407-930-4348
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9480041163WP0808X
FLAPRN11025798363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health