Provider Demographics
NPI:1972937746
Name:MANUEL, KIM MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:MANUEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:MELVIN-DESILVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3627 UNIVERSITY BLVD S STE 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4294
Mailing Address - Country:US
Mailing Address - Phone:904-593-0760
Mailing Address - Fax:904-398-1729
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4294
Practice Address - Country:US
Practice Address - Phone:904-593-0760
Practice Address - Fax:904-398-1729
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9171791363LA2200X
FLAPRN9171791363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137439AMedicaid
FL009463500Medicaid
GA003137439BMedicaid
GA003137439AMedicaid
FLHN892YMedicare PIN