Provider Demographics
NPI:1083469100
Name:KISSEL, MADISON NICOLE (DNP-FNP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:KISSEL
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SEA GROVE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6761
Mailing Address - Country:US
Mailing Address - Phone:904-955-1027
Mailing Address - Fax:
Practice Address - Street 1:9119 MERRILL RD STE 38
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4306
Practice Address - Country:US
Practice Address - Phone:904-269-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily