Healthcare Provider Details

I. General information

NPI: 1407707201
Provider Name (Legal Business Name): KATHLEEN ANNE NOLAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1697 KINGS RD STE 1
JACKSONVILLE FL
32209-6169
US

IV. Provider business mailing address

153 FERROL RD
ST AUGUSTINE FL
32084-2966
US

V. Phone/Fax

Practice location:
  • Phone: 904-478-5483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11031274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: