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NPI Code Detail

MEDICARE: JENNY KIDD NICKLESS DNP, ARNP

MEDICARE: JENNY KIDD NICKLESS DNP, ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN11044599FL
2363LF0000XFamily Nurse PractitionerRN9297117FL

General Provider Information

NPI Number : 1326916875
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY KIDD NICKLESS DNP, ARNP
Provider Business Mailing Address
First Line : 336 TWELVE OAKS DR
Second Line :
City : WINTER SPRINGS
State : FL
Zip : 32708-6192
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8701 MAITLAND SUMMIT BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32810-5915
Country : US
Telephone Number : 407-200-2759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2025
Last Update Date : 01/21/2026

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