MEDICARE: KATHLEEN ANNE NOLAN APRN

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
1	207Q00000X	Family Medicine Physician	APRN11031274	FL

General Provider Information

NPI Number	:	1407707201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANNE NOLAN APRN

Provider Business Mailing Address
First Line	:	153 FERROL RD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32084-2966
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1697 KINGS RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6169
Country	:	US
Telephone Number	:	904-478-5483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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