Individual
KIMBERLY DIANE MACKAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 244-3508
(904) 244-4301
Mailing address
PO BOX 44008, JACKSONVILLE, FL 32231-4008
(904) 244-3508
(904) 244-4301
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
683428
TX
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
APRN11030321
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN11030321
FLORIDA APRN LIC
FL
Enumeration date
12/14/2019
Last updated
01/30/2024
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