Provider Demographics
NPI:1558955849
Name:RENNER, KATHLEEN R (APRN)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:R
Last Name:RENNER
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:4147 SOUTHPOINT DR EAST
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-332-6774
Mailing Address - Fax:
Practice Address - Street 1:4147 SOUTHPOINT DR EAST
Practice Address - Street 2:OPTIONAL
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3221
Practice Address - Country:US
Practice Address - Phone:904-332-6774
Practice Address - Fax:904-661-0028
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008064208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery