Healthcare Provider Details

I. General information

NPI: 1104453455
Provider Name (Legal Business Name): KALEI MARIE ROLLINS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR STE 1400
JACKSONVILLE FL
32207-8364
US

IV. Provider business mailing address

13810 SUTTON PARK DR N UNIT 319
JACKSONVILLE FL
32224-4241
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax:
Mailing address:
  • Phone: 239-877-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS19680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: