Basic Information
| Provider Information | |||||||||
| NPI: | 1861967887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELUNA ROSZELL | ||||||||
| FirstName: | KINDRED | ||||||||
| MiddleName: | MARIE CORSAME | ||||||||
| NamePrefix: | |||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2147 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339022147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393439800 | ||||||||
| FaxNumber: | 2393439848 | ||||||||
| Practice Location | |||||||||
| Address1: | 13340 METRO PKWY STE 1000 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339664819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393430490 | ||||||||
| FaxNumber: | 2393430499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2018 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN9284945 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 101316400 | 05 | FL | MEDICAID |