Individual provider Active NPI

Kellie Marie Cardenas, CRNA

  • Certified Registered Nurse Anesthetist
  • Port Saint Lucie, FL
National Provider Identifier
1508360991
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
ARNP9341938 Issued in FL
Practice address
1800 SE Tiffany Ave
Port Saint Lucie, FL 34952
Phone
(772) 335-4000
NPI assigned
Mar 20, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X ARNP9341938 FL Primary
Registered Nurse 163W00000X RN9341938 FL

Addresses

Primary practice location

1800 SE Tiffany Ave
Port Saint Lucie, FL 34952

Mailing address

178 SW Glenwood Dr
Port Saint Lucie, FL 34984-5025
Phone (772) 240-4188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190123002022 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3476890864 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1800 SE Tiffany Ave
Port Saint Lucie, FL 34952-7521
Phone (954) 939-5000

5301 S Congress Ave
Atlantis, FL 33462-1149
Phone (954) 939-5000

7201 N University Dr
Tamarac, FL 33321-2913
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN9341938FLMDRegistered Nurse
ARNP9341938FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered CurrentSince Aug 27, 2018 Accepting new patients
Anesthesia Physician Solutions of South Florida, LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 27, 2018 Accepting new patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
Sheridan Healthcorp, Inc. CurrentSince Aug 27, 2018 Accepting new patients
Anesthesia Physician Solutions of South Florida, LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 27, 2018 Accepting new patients
Anesthesia Physician Solutions of South Florida, LLC Nurse Anesthetist, Certified Registered Current Accepting new patients

Locations

5301 S Congress Ave
Lantana, FL 33462
Phone (561) 548-3549

401 NW 42nd Ave
Plantation, FL 33317
Phone (954) 513-6434

1800 SE Tiffany Ave
Port St Lucie, FL 34952
Phone (772) 398-1969

1613 NW 136th Ave
Ste 200
Sunrise, FL 33323
Phone (954) 838-2502

7201 N University Dr
Tamarac, FL 33321
Phone (954) 721-2200

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534464000000",
    "number": "1508360991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 SW GLENWOOD DR",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349845025",
            "telephone_number": "772-240-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 SE TIFFANY AVE",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "34952",
            "telephone_number": "772-335-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARDENAS",
        "first_name": "KELLIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-20",
        "last_updated": "2018-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP9341938",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9341938",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.