Provider Demographics
NPI:1518048560
Name:LANEVE, KIRK ANTHONY (PA)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:ANTHONY
Last Name:LANEVE
Suffix:
Gender:M
Credentials:PA
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Other - Middle Name:
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Mailing Address - Street 1:7855 ARGYLE FOREST BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5596
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-619-1080
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 435
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4230
Practice Address - Country:US
Practice Address - Phone:904-269-1930
Practice Address - Fax:904-269-1151
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-02-10
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA557899628AMedicaid
FL2925940-00Medicaid
FL2925940-00Medicaid
GA557899628AMedicaid