Provider Demographics
NPI:1952185894
Name:KINKEL, MARK DAVID (MSN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:KINKEL
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 E OAKLAND PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4434
Mailing Address - Country:US
Mailing Address - Phone:954-565-0875
Mailing Address - Fax:954-565-0876
Practice Address - Street 1:1421 E OAKLAND PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4434
Practice Address - Country:US
Practice Address - Phone:954-565-0875
Practice Address - Fax:954-565-0876
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty