Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN9184456 | FL |
NPI | 1578831954 |
---|---|
Provider Name | Kimberly Anne Greenawalt |
First Address | Jacksonville, FL 32216-1471 |
Second Address | Jacksonville, FL 32216-1471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2011 |
Last Update Date | 18/03/2015 |