Provider Demographics
NPI:1124334602
Name:WASHBURN, KATHLEEN PURCELL (PHD, ARNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:PURCELL
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:PHD, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 NORTH 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-0484
Mailing Address - Country:US
Mailing Address - Phone:904-653-4700
Mailing Address - Fax:904-653-4710
Practice Address - Street 1:155 NORTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-0484
Practice Address - Country:US
Practice Address - Phone:904-653-4700
Practice Address - Fax:904-653-4710
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2014-01-13
Deactivation Date:2012-09-06
Deactivation Code:
Reactivation Date:2012-10-19
Provider Licenses
StateLicense IDTaxonomies
FL0941372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner