Healthcare Provider Details

I. General information

NPI: 1932534823
Provider Name (Legal Business Name): QUAWENDELLA BAEJUHNE SKINNER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 KINGSLEY AVE STE 7
ORANGE PARK FL
32073-4418
US

IV. Provider business mailing address

1734 KINGSLEY AVE STE 7
ORANGE PARK FL
32073-4418
US

V. Phone/Fax

Practice location:
  • Phone: 904-474-9766
  • Fax: 877-847-8552
Mailing address:
  • Phone: 904-474-9766
  • Fax: 877-847-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: