Provider Demographics
NPI:1740727593
Name:NOLAN, KIRSTEN (ARNP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:NOLAN
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 1:601 E DIXIE AVE
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5953
Mailing Address - Country:US
Mailing Address - Phone:352-787-9448
Mailing Address - Fax:352-787-3250
Practice Address - Street 1:601 E DIXIE AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5953
Practice Address - Country:US
Practice Address - Phone:352-787-9448
Practice Address - Fax:352-787-3250
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9343651363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health