Provider Demographics
NPI:1952595472
Name:KADLUBOWSKI, AMY L (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:KADLUBOWSKI
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:5101 GATE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7275
Mailing Address - Country:US
Mailing Address - Phone:904-396-1186
Mailing Address - Fax:904-396-0228
Practice Address - Street 1:5101 GATE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7275
Practice Address - Country:US
Practice Address - Phone:904-396-1186
Practice Address - Fax:904-396-0228
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9177259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily