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General NPI Number Information
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NPI Number | 1003561747
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Entity Type | Individual
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Provider Name | GINA A. KELLY-VASQUEZ DNP
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Gender | Female
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 1 UNF DR
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2645
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Country | US
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Telephone | 904-620-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 13553 AQUILINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32224-3006
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Country | US
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Telephone | 904-412-1069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11018073
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License Number State | FL
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