NPIMap

Organization Active NPI

Kpncinc

  • Nursing Facility/Intermediate Care Facility
  • Jacksonville, FL
National Provider Identifier
1629414479
Registry record updated May 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
6906603 Issued in FL
Legal business name
KPNCINC
Practice address
764 Aqua Surf CT
Jacksonville, FL 32225-0802
Phone
(904) 554-6051
Fax
(904) 361-3235
NPI assigned
May 21, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2013

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

Authorized official

Name
Agelet St Hubert
Title
Owner/President
Phone
(904) 554-6051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 6906603 FL Primary

Addresses

Primary practice location

764 Aqua Surf CT
Jacksonville, FL 32225-0802

Mailing address

764 Aqua Surf CT
Jacksonville, FL 32225-0802
Phone (904) 554-6051

Other identifiers 1

IdentifierTypeStateIssuer
000568100MedicaidFL

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369094400000",
    "number": "1629414479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "764 AQUA SURF CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322250802",
            "telephone_number": "904-554-6051",
            "fax_number": "904-361-3235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "764 AQUA SURF CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322250802",
            "telephone_number": "904-554-6051",
            "fax_number": "904-361-3235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KPNCINC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-21",
        "last_updated": "2013-05-21",
        "status": "A",
        "authorized_official_last_name": "ST HUBERT",
        "authorized_official_first_name": "AGELET",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "904-554-6051"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "FL",
            "license": "6906603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000568100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; 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.