Healthcare Provider Details

I. General information

NPI: 1336717081
Provider Name (Legal Business Name): KALLI A ACKERMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75980 WILLIAM BURGESS BLVD UNIT 3
YULEE FL
32097-5518
US

IV. Provider business mailing address

75980 WILLIAM BURGESS BLVD UNIT 3
YULEE FL
32097-5518
US

V. Phone/Fax

Practice location:
  • Phone: 904-530-4951
  • Fax:
Mailing address:
  • Phone: 904-530-4951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11013686
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11013686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: