Provider Demographics
NPI:1396353967
Name:KINCADE, JENNIFER (RN, BSN, CCRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KINCADE
Suffix:
Gender:F
Credentials:RN, BSN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 CONNEMARA CIR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-8957
Mailing Address - Country:US
Mailing Address - Phone:248-202-1089
Mailing Address - Fax:
Practice Address - Street 1:1418 CONNEMARA CIR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-8957
Practice Address - Country:US
Practice Address - Phone:248-202-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9519240163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse