MEDICARE: KIM MARIE MANUEL 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
1	363LA2200X	Adult Health Nurse Practitioner	ARNP9171791	FL
2	363L00000X	Nurse Practitioner	APRN9171791	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972937746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM MARIE MANUEL ARNP

Provider Business Mailing Address
First Line	:	3627 UNIVERSITY BLVD S STE 305
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4294
Country	:	US
Telephone Number	:	904-593-0760
Fax Number	:	904-398-1729

Provider Business Practice Location Address
First Line	:	3627 UNIVERSITY BLVD S STE 305
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4294
Country	:	US
Telephone Number	:	904-593-0760
Fax Number	:	904-398-1729

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

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	06/02/2022

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Directions to “ KIM MARIE MANUEL ARNP” Practice Location

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