Provider Demographics
NPI:1558451781
Name:DEMELE, KELLY S (APRN-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:DEMELE
Suffix:
Gender:
Credentials:APRN-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:SCOTT
Other - Last Name:DEMELE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-C
Mailing Address - Street 1:333 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2661
Mailing Address - Country:US
Mailing Address - Phone:888-033-3708
Mailing Address - Fax:888-803-3331
Practice Address - Street 1:400 N TAMPA ST FL 15
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4730
Practice Address - Country:US
Practice Address - Phone:888-033-3708
Practice Address - Fax:888-803-3331
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175383363LF0000X
IAA177745363LF0000X
MI4704335452363LF0000X
WA60769944363LF0000X
FL9190390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052602901Medicaid
FL052602901Medicaid