Basic Information
| Provider Information | |||||||||
| NPI: | 1992245088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDUFFIE | ||||||||
| FirstName: | KIA | ||||||||
| MiddleName: | NISSAN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN ARNP FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2706 93RD CT E | ||||||||
| Address2: | |||||||||
| City: | PALMETTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342211707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414486400 | ||||||||
| FaxNumber: | 8554332010 | ||||||||
| Practice Location | |||||||||
| Address1: | 2706 93RD CT E | ||||||||
| Address2: | |||||||||
| City: | PALMETTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342211707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414486400 | ||||||||
| FaxNumber: | 8554332010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2017 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9303986 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.