Provider Demographics
NPI:1114683315
Name:MIJIC, KADIAN RENAE (AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:KADIAN
Middle Name:RENAE
Last Name:MIJIC
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-8307
Mailing Address - Country:US
Mailing Address - Phone:352-405-1125
Mailing Address - Fax:
Practice Address - Street 1:10221 YALE AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-8307
Practice Address - Country:US
Practice Address - Phone:352-405-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010538363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner