Provider Demographics
NPI:1083993703
Name:BAIRD, KIMBERLY ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:BAIRD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 LAKE MEAD AVE
Mailing Address - Street 2:STE 531
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9733
Mailing Address - Country:US
Mailing Address - Phone:904-419-2054
Mailing Address - Fax:904-419-2057
Practice Address - Street 1:11512 LAKE MEAD AVE
Practice Address - Street 2:SUITE 532
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9733
Practice Address - Country:US
Practice Address - Phone:904-419-2054
Practice Address - Fax:904-419-2057
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9249739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003565900Medicaid