Provider Demographics
NPI:1114190394
Name:LAUKHUF, KYLEE (ARNP)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:LAUKHUF
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:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:5205 NORMANDY BLVD STE 13
Practice Address - Street 2:UFJAX - MURRAY HILL FAMILY PRACTICE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4842
Practice Address - Country:US
Practice Address - Phone:904-633-0500
Practice Address - Fax:904-633-0549
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9223055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002613100Medicaid
FLAK462XMedicare PIN
FLAK462WMedicare PIN