Healthcare Provider Details

I. General information

NPI: 1073677621
Provider Name (Legal Business Name): CHRISTINE JANE MCKENNA RN MSN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1811 SE 59TH ST
OCALA FL
34480-6687
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone: 352-622-6705
  • Fax: 352-622-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2077072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: