Healthcare Provider Details

I. General information

NPI: 1114845013
Provider Name (Legal Business Name): JAIDEN KRAFT FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HERON BAY RD
JACKSONVILLE FL
32218-3595
US

IV. Provider business mailing address

2435 NORCROSS SPRINGS WAY APT 6308
KNOXVILLE TN
37931-2415
US

V. Phone/Fax

Practice location:
  • Phone: 904-470-6900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048990
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: