Patricia Anne Kisselback, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

11020827 Issued in FL

Practice address

7790 Winter Garden Vineland Rd Ste 100
Windermere, FL 34786-5896

Phone

(407) 347-0101

NPI assigned

Jul 26, 2022

Last updated

Oct 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1295461960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HOPKINS CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328045909",
            "telephone_number": "561-531-1491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7790 WINTER GARDEN VINELAND RD STE 100",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347865896",
            "telephone_number": "407-347-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSELBACK",
        "first_name": "PATRICIA",
        "middle_name": "ANNE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-26",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11020827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Windermere, FL
• Providers in Windermere, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.