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General NPI Number Information
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NPI Number | 1275887531
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Entity Type | Individual
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Provider Name | KANDI MARI HEATH RN-FNP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 105 JULINGTON PLAZA DR STE A
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City | JACKSONVILLE
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State | FL
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Zip | 32259-6218
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Country | US
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Telephone | 904-582-1193
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Fax |
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Provider Business Mailing Address
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Address Line | 290 BLUEJACK LN
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32095-9029
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Country | US
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Telephone | 304-534-0684
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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 | APRN75923-FNP-BC
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AC005770
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1108172
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License Number State | FL
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