Healthcare Provider Details

I. General information

NPI: 1801460910
Provider Name (Legal Business Name): KENNETH C REES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14534 OLD SAINT AUGUSTINE RD STE 3210
JACKSONVILLE FL
32258-2645
US

IV. Provider business mailing address

11945 SAN JOSE BLVD STE 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 904-675-4000
  • Fax: 904-675-4007
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-396-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: