Provider Demographics
NPI:1346757705
Name:KELLOGG, EVA M (ARNP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:M
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:M
Other - Last Name:BROGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7807 BAYMEADOWS RD E STE 208
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9666
Mailing Address - Country:US
Mailing Address - Phone:904-330-0302
Mailing Address - Fax:904-340-0418
Practice Address - Street 1:7807 BAYMEADOWS RD E STE 208
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-330-0302
Practice Address - Fax:904-330-0418
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9238011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner