Provider Demographics
NPI:1194164269
Name:MAYNARD, KATHERINE DELORES (ARNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DELORES
Last Name:MAYNARD
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95186 SNAPDRAGON DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-0029
Mailing Address - Country:US
Mailing Address - Phone:043-277-0969
Mailing Address - Fax:
Practice Address - Street 1:95186 SNAPDRAGON DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-0029
Practice Address - Country:US
Practice Address - Phone:904-327-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287792363LF0000X
FLAPRN9287792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily