Provider Demographics
NPI:1831168863
Name:ISAACSON, KIMBERLY K (CRNA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:K
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:CRNA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3660
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP ANESTHESIA DEPT.
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4195
Practice Address - Fax:904-244-4908
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9198107363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000981362AMedicaid
GA000981362BMedicaid
FL3052486-00Medicaid
FLU0045Medicare PIN
FL430079624Medicare PIN