Healthcare Provider Details

I. General information

NPI: 1417385949
Provider Name (Legal Business Name): MANJIT KAUR KAELEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 EDGEWOOD AVE N
JACKSONVILLE FL
32254-3013
US

IV. Provider business mailing address

326 PABLO RD
PONTE VEDRA BEACH FL
32082-1806
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0510
  • Fax:
Mailing address:
  • Phone: 904-686-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9287546
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number476072-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00137341
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9287546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: