| NPI | 1265762413 |
|---|---|
| Former Name | TINA TERESA KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 10120) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 415820) |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2010-01-12 |