Healthcare Provider Details

I. General information

NPI: 1366462392
Provider Name (Legal Business Name): CAROLYN ANN REIKENIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN ANN KIRBY ARNP

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CONTINENTAL DR STE A FMC DIALYSIS SERVICES WPB, CKD SERVICES
WEST PALM BEACH FL
33407-3207
US

IV. Provider business mailing address

701 WARREN DR
JUPITER FL
33458-4036
US

V. Phone/Fax

Practice location:
  • Phone: 561-840-4141
  • Fax: 561-840-4011
Mailing address:
  • Phone: 561-745-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1004002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: