1972799492 NPI number — CORI BRETT KLEINFELD MSN, ARNP-NNP

Table of content: CORI BRETT KLEINFELD MSN, ARNP-NNP (NPI 1972799492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972799492 NPI number — CORI BRETT KLEINFELD MSN, ARNP-NNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEINFELD
Provider First Name:
CORI
Provider Middle Name:
BRETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, ARNP-NNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972799492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 44008
Provider Second Line Business Mailing Address:
UFJAX - PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32231-4008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-244-3199
Provider Business Mailing Address Fax Number:
904-244-3425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 PRUDENTIAL DR
Provider Second Line Business Practice Location Address:
UFJAX - DEPT. OF PEDIATRICS/NEONATOLOGY
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-8210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-202-2330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0005X , with the licence number:  APN0000011967 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0000X , with the licence number: ARNP 9338095 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 007185800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003140202A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003140202B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007185800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".