Individual provider Active NPI

Kayla N Fornal, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Venice, FL
National Provider Identifier
1710555123
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11013641 Issued in FL
Practice address
171 Center Rd
Venice, FL 34285-5572
Phone
(833) 674-2500
Fax
(941) 764-8455
NPI assigned
Jun 12, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11013641 FL Primary

Addresses

Primary practice location

171 Center Rd
Venice, FL 34285-5572

Mailing address

2675 Winkler Ave Ste 200
Fort Myers, FL 33901-9328
Phone (877) 856-3774

Other practice location 1

15201 N Cleveland Ave Ste 1010
North Fort Myers, FL 33903-2717
Phone (833) 674-2500

Other practice location 2

2020 Main St
Sarasota, FL 34237-6022
Phone (941) 861-4750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210723002525 FL Practitioner - Nurse Practitioner 4284037581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

171 Ctr Rd
Venice, FL 34285-5572
Phone (941) 499-5407

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN11013641FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC CurrentSince Jul 26, 2021 Accepting new patients
Millennium Physician Group LLC CurrentSince Jul 26, 2021 Accepting new patients

Locations

2675 Winkler Ave
Ste 200
Fort Myers, FL 33901

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

1250 Tamiami Trl N
Ste 305
Naples, FL 34102
Phone (239) 252-5005

15201 N Cleveland Ave
Ste 1010
North Fort Myers, FL 33903
Phone (833) 674-2500

3434 Hancock Bridge Pkwy
Ste 301
North Ft Myers, FL 33903
Phone 877856377411108

3434 Hancock Bridge Pkwy
North Ft Myers, FL 33903

3067 Tamiami Trl
Ste 4
Pt Charlotte, FL 33952
Phone (941) 391-5522

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

171 Center Rd
Venice, FL 34285
Phone (833) 674-2500

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: kayla.fornal.1@4290.direct.athenahealth.com

Organizations & group practices 2

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 5

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": "1623456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1710555123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE STE 200",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019328",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 CENTER RD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342855572",
            "telephone_number": "833-674-2500",
            "fax_number": "941-764-8455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15201 N Cleveland Ave Ste 1010",
            "address_purpose": "LOCATION",
            "city": "North Fort Myers",
            "state": "FL",
            "postal_code": "339032717",
            "country_code": "US",
            "telephone_number": "833-674-2500",
            "fax_number": "239-599-4126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2020 Main St",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342376022",
            "country_code": "US",
            "telephone_number": "941-861-4750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORNAL",
        "first_name": "KAYLA",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "DNP, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-12",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11013641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

Verify at the official NPI Registry.