Provider Demographics
NPI:1033143672
Name:KIRKLAND, CAROL J (ARNP, CPNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 STATE HIGHWAY 1959
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-7139
Mailing Address - Country:US
Mailing Address - Phone:606-474-5336
Mailing Address - Fax:
Practice Address - Street 1:4880 N HIGHWAY 19A
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2018
Practice Address - Country:US
Practice Address - Phone:352-589-8111
Practice Address - Fax:352-589-8495
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9204749363LP0200X
KY3002939363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1076616OtherREGISTERED NURSE LIC NO.
FLARNP 9204749OtherARNP LICENSE NO.
KY3002939OtherKY APRN
FL307129400Medicaid
FL307129400Medicaid