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General NPI Number Information
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NPI Number | 1619868908
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Entity Type | Individual
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Provider Name | LAURA E KIDDER APRN
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Gender | Female
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 9310 OLD KINGS RD S STE 1303
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8100
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Country | US
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Telephone | 904-900-3472
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Fax |
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Provider Business Mailing Address
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Address Line | 6313 OLETA WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32258-3135
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Country | US
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Telephone | 517-862-3799
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11040862
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License Number State | FL
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