Provider Demographics
NPI:1689379877
Name:KONDA, PRIYA (FNP-C)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:KONDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 PALM ST STE 1
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-5100
Mailing Address - Country:US
Mailing Address - Phone:321-984-4600
Mailing Address - Fax:
Practice Address - Street 1:990 PALM ST STE 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-5100
Practice Address - Country:US
Practice Address - Phone:321-639-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2024-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025509363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner