Provider Demographics
NPI:1356062160
Name:KENNEDY, ERIN (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CENTERVILLE RD STE 5400
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4654
Mailing Address - Country:US
Mailing Address - Phone:419-790-8103
Mailing Address - Fax:
Practice Address - Street 1:1405 CENTERVILLE RD STE 5400
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4654
Practice Address - Country:US
Practice Address - Phone:419-790-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily