Provider Demographics
NPI:1821804659
Name:KAKLIS, MADELINE NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:NICOLE
Last Name:KAKLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:559-632-1008
Mailing Address - Fax:239-236-2775
Practice Address - Street 1:19520 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5200
Practice Address - Country:US
Practice Address - Phone:301-593-9035
Practice Address - Fax:301-593-9036
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner