MEDICARE: EMMA KLECKNER DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11047787	FL

General Provider Information

NPI Number	:	1295668028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA KLECKNER DNP

Provider Business Mailing Address
First Line	:	5191 FIRST COAST TECH PKWY FL 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-0609
Country	:	US
Telephone Number	:	904-223-3321
Fax Number	:	904-223-2169

Provider Business Practice Location Address
First Line	:	1100 PLANTATION ISLAND DR S STE 220
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-5174
Country	:	US
Telephone Number	:	904-223-3321
Fax Number	:	904-223-2169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/04/2026

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