Individual
MS. KATHLEEN ELLEN MULLEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
3599 UNIVERSITY BLVD S, JACKSONVILLE, FL 32216-4252
(904) 345-7776
(904) 345-7772
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP1985832
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306261900
—
FL
01
—
P00153960
RAILROAD MEDICARE
FL
01
—
Y050T
BLUECROSS/BLUESHIELD
FL
Enumeration date
10/29/2005
Last updated
11/29/2016
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