Provider Demographics
NPI:1083643399
Name:DUNCAN, JACQUELINE (ARNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:KALVAITIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6151 N SUNCOAST BLVD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-2984
Mailing Address - Country:US
Mailing Address - Phone:352-794-0878
Mailing Address - Fax:352-794-0877
Practice Address - Street 1:6151 N SUNCOAST BLVD
Practice Address - Street 2:SUITE 1C
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-2984
Practice Address - Country:US
Practice Address - Phone:352-794-0878
Practice Address - Fax:352-794-0877
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9206112363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3069249Medicaid