NPIMap

Individual provider Active NPI

Kelly Ferrara

  • Nurse Practitioner
  • Daytona Beach, FL
National Provider Identifier
1598326571
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11002839 Issued in FL
Practice address
1890 Lpga Blvd Ste 140
Daytona Beach, FL 32117-7131
Phone
(386) 231-3284
NPI assigned
Jun 21, 2019
Last updated
Apr 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11002839 FL Primary

Addresses

Primary practice location

1890 Lpga Blvd Ste 140
Daytona Beach, FL 32117-7131

Mailing address

1890 Lpga Blvd Ste 140
Daytona Beach, FL 32117-7131
Phone (386) 231-3284

Other practice location 1

8212 White Rock Cir
Boynton Beach, FL 33436-1744
Phone (561) 702-5606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200420000052 FL Practitioner - Nurse Practitioner 6103256912 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endocrinology of Central Florida PAGroup PAC ID 5597731380, 6 clinicians

Practice addresses (Care Compare)

141 Victoria Commons Blvd
Deland, FL 32724-7700
Phone (386) 427-4544

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11002839FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Town Center Family Practice Inc CurrentSince Apr 16, 2023 Accepting new patients
Endocrinology of Central Florida PA CurrentSince Sep 16, 2024 Accepting new patients
Florida Health Care Plan, Inc Past Accepting new patients

Locations

141 Victoria Commons Blvd
Deland, FL 32724
Phone (386) 427-4544

141 Victoria Commons Blvd
Ste 1003
Deland, FL 32724

109 W Knapp Ave
Edgewater, FL 32132
Phone (386) 427-4544

1642 N Volusia Ave
Orange City, FL 32763
Phone (386) 232-9288

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIGHCA
  • FHIR API: https://fhir4.healow.com/fhir/r4/HIBCAA

Organizations & group practices 3

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

Hospital & facility affiliations 8

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": "1561075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1598326571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD STE 140",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177131",
            "telephone_number": "386-231-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD STE 140",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177131",
            "telephone_number": "386-231-3284"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8212 White Rock Cir",
            "address_purpose": "LOCATION",
            "city": "Boynton Beach",
            "state": "FL",
            "postal_code": "334361744",
            "country_code": "US",
            "telephone_number": "561-702-5606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERRARA",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-21",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11002839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.