MEDICARE: STEPHANIE BACKOF HOLMES KINNARE PSYCHOLOGIST

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	103T00000X	Psychologist	PY8730	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841637428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BACKOF HOLMES KINNARE PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	12724 GRAN BAY PKWY W STE 410
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-9486
Country	:	US
Telephone Number	:	904-574-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	12724 GRAN BAY PKWY W STE 410
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-9486
Country	:	US
Telephone Number	:	904-574-5200
Fax Number	:

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

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	09/30/2025

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Directions to “ STEPHANIE BACKOF HOLMES KINNARE PSYCHOLOGIST” Practice Location

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