Provider Demographics
NPI:1982075529
Name:KIDARY, GERALDINE (ARNP)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:KIDARY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PEMBROOK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6378
Mailing Address - Country:US
Mailing Address - Phone:407-925-4395
Mailing Address - Fax:407-550-7416
Practice Address - Street 1:1800 PEMBROOK DR STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6378
Practice Address - Country:US
Practice Address - Phone:407-925-4395
Practice Address - Fax:407-550-7416
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2915692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily