| NPI | 1902284367 |
|---|---|
| Former Name | KELLY ANNE ULLOA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9292731) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9292731) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2021-02-10 |