Provider Demographics
NPI:1366462392
Name:REIKENIS, CAROLYN ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANN
Last Name:REIKENIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:701 WARREN DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4036
Mailing Address - Country:US
Mailing Address - Phone:561-745-0350
Mailing Address - Fax:
Practice Address - Street 1:2000 CONTINENTAL DR
Practice Address - Street 2:STE A FMC DIALYSIS SERVICES WPB, CKD SERVICES
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3207
Practice Address - Country:US
Practice Address - Phone:561-840-4141
Practice Address - Fax:561-840-4011
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1004002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner