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General NPI Number Information
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NPI Number | 1952818809
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Entity Type | Individual
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Provider Name | KATHLEEN A GANNON APRN
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Gender | Female
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Dates
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Enumeration Date | 01/01/2018
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 3563 PHILIPS HWY BLDG. B SUITE 201A
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32207
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Country | US
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Telephone | 904-202-2557
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Fax | 904-393-2958
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Provider Business Mailing Address
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Address Line | PO BOX 746636
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City | ATLANTA
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State | GA
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Zip | 30374-6636
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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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 | 71007340A
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License Number State | IN
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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 | APRN11035733
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11035733
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License Number State | FL
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