Provider Demographics
NPI:1437376324
Name:MCGUIRE, KELLIE ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ANN
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:MCGUIRE-O'SHEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6410
Mailing Address - Fax:239-343-4014
Practice Address - Street 1:946 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1308
Practice Address - Country:US
Practice Address - Phone:973-743-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032696363LF0000X
NYF332076363LF0000X
NJ26NN08534500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0554651Medicaid
FL122417400Medicaid