Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | ARNP3014012 | FL |
NPI | 1003884347 |
---|---|
Provider Name | Mr. Nicholas M Kalynych |
First Address | Ponte Vedra, FL 32081-0611 |
Second Address | Ponte Vedra, FL 32081-0611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2006 |
Last Update Date | 11/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000892009A | (05) | GA |
3034364-00 | (05) | FL |
G20357 | BLUE CROSS / BLUE SHIELD NUMBER (01) | FL |
P18940 | (02) | FL |