Provider Demographics
NPI:1972569770
Name:KLEYNEN, JUDY ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:KLEYNEN
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 1:1549 SOUTH JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344
Mailing Address - Country:US
Mailing Address - Phone:850-997-0707
Mailing Address - Fax:850-997-6833
Practice Address - Street 1:1549 S. JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344
Practice Address - Country:US
Practice Address - Phone:850-997-0707
Practice Address - Fax:850-997-6833
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1272302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS72919Medicare UPIN
FLE20672Medicare ID - Type UnspecifiedMEDICARE NUMBER