Healthcare Provider Details

I. General information

NPI: 1447295878
Provider Name (Legal Business Name): JILL KINLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5503 S CONGRESS AVE SUITE 206
ATLANTIS FL
33462-6625
US

IV. Provider business mailing address

5503 S CONGRESS AVE SUITE 206
ATLANTIS FL
33462-6625
US

V. Phone/Fax

Practice location:
  • Phone: 561-434-0353
  • Fax:
Mailing address:
  • Phone: 561-434-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 781942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: