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General NPI Number Information
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NPI Number | 1124799663
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Entity Type | Individual
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Provider Name | KATHLYN ELISE BAXTER MSN, AGACNP, CCRN
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Gender | Female
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Dates
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Enumeration Date | 09/24/2021
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 2001 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5148
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Country | US
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Telephone | 904-639-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 12147 WARWICK CIR
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City | PARRISH
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State | FL
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Zip | 34219-7535
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9452667
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 11041021
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License Number State | FL
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