Provider Demographics
NPI:1891516993
Name:TANNOCK, KELLIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:
Last Name:TANNOCK
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 SE 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3721
Mailing Address - Country:US
Mailing Address - Phone:352-843-7366
Mailing Address - Fax:
Practice Address - Street 1:1009 SW 16TH LN
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1228
Practice Address - Country:US
Practice Address - Phone:352-351-3413
Practice Address - Fax:352-629-6667
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035483363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner