Provider Demographics
NPI:1750333415
Name:KIRKPATRICK, JUDITH (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1545 AIRPORT BLVD
Practice Address - Street 2:SUITE 2000
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8615
Practice Address - Country:US
Practice Address - Phone:850-416-6933
Practice Address - Fax:850-416-6934
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1369972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300793600Medicaid
FL300793600Medicaid
Y69242Medicare ID - Type Unspecified