Provider Demographics
NPI:1609649235
Name:KANTAREVIC, MARIJA GLODEVIC (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARIJA
Middle Name:GLODEVIC
Last Name:KANTAREVIC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 HOLLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8459
Mailing Address - Country:US
Mailing Address - Phone:904-673-8091
Mailing Address - Fax:
Practice Address - Street 1:7751 BAYMEADOWS RD E STE 205
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5836
Practice Address - Country:US
Practice Address - Phone:904-239-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9316148163W00000X
FL11033264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse