Healthcare Provider Details

I. General information

NPI: 1730426578
Provider Name (Legal Business Name): MRS. JENNIFER ANN KUHLKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JENNIFER ANN YACKEY

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BLANDING BLVD
ORANGE PARK FL
32073
US

IV. Provider business mailing address

410 BLANDING BLVD
ORANGE PARK FL
32073
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-6035
  • Fax:
Mailing address:
  • Phone: 904-276-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: