Provider Demographics
NPI:1912029968
Name:O'NEIL, KIRSTEN (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 ATLANTIC AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3650
Mailing Address - Country:US
Mailing Address - Phone:904-322-8047
Mailing Address - Fax:904-329-4637
Practice Address - Street 1:1001 ATLANTIC AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3650
Practice Address - Country:US
Practice Address - Phone:904-322-8047
Practice Address - Fax:866-552-5911
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64122207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA340809501AMedicaid
FL2643553-00Medicaid
FL44867YMedicare PIN