Stacy Rae Kiseljack, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

ARNP2744942 Issued in FL

Practice address

1443 San Marco Blvd
Ufjp Pediatric Cardiovascular Center
Jacksonville, FL 32207-8565

Phone

(904) 306-3962

Fax

(904) 493-2363

NPI assigned

Mar 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287619200000",
    "number": "1356300578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "address_2": "UFJP PROVIDER ENROLLMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008",
            "telephone_number": "904-244-3199",
            "fax_number": "904-244-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1443 SAN MARCO BLVD",
            "address_2": "UFJP PEDIATRIC CARDIOVASCULAR CENTER",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078565",
            "telephone_number": "904-306-3962",
            "fax_number": "904-493-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISELJACK",
        "first_name": "STACY",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2010-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP2744942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3040267-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ron Kirsner, M.D.
• Malissa Ann Kirsten, A.P.R.N.
• Christine Kirts, PA-C
• Waynettia Maria Kirtsey, MA, LMHC
• Jennifer Kirvin, PHARMD
• Ashley Vickery Kiser, M.S., BCBA
• Ruby Kish, RN, LCSW
• Rami Kishek
• Hiten Vithal Kisnad, M.D.
• Madison Nicole Kissel, DNP-FNP

• Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.