Healthcare Provider Details

I. General information

NPI: 1417286436
Provider Name (Legal Business Name): KELLEY ANN SOLOSKY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY ANN MAHAN CRNP

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9889 GATE PKWY N STE 303
JACKSONVILLE FL
32246-9230
US

IV. Provider business mailing address

565 STATELY SHOALS TRL
PONTE VEDRA FL
32081-5049
US

V. Phone/Fax

Practice location:
  • Phone: 904-300-2809
  • Fax: 888-496-8341
Mailing address:
  • Phone: 302-893-5031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN542909
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP010687
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: