Provider Demographics
NPI:1013581750
Name:KENNEDY, GENTINA VICTORIA (APRN)
Entity Type:Individual
Prefix:
First Name:GENTINA
Middle Name:VICTORIA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 SYCAMORE WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-1675
Mailing Address - Country:US
Mailing Address - Phone:904-322-6036
Mailing Address - Fax:
Practice Address - Street 1:4266 SUNBEAM RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2425
Practice Address - Country:US
Practice Address - Phone:904-407-7700
Practice Address - Fax:904-407-6001
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11005594363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health