Healthcare Provider Details

I. General information

NPI: 1336073253
Provider Name (Legal Business Name): KIRSTIE OWENS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 MAX LEGGETT PKWY
JACKSONVILLE FL
32218-7273
US

IV. Provider business mailing address

14 SANDRA DR
JACKSONVILLE BEACH FL
32250-4039
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1000
  • Fax:
Mailing address:
  • Phone: 904-699-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11048180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: