Provider Demographics
NPI:1871067801
Name:SZUBA, KRISTEN GOODYEAR (MSN, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GOODYEAR
Last Name:SZUBA
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 PRUDENTIAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8346
Mailing Address - Country:US
Mailing Address - Phone:904-633-4110
Mailing Address - Fax:904-633-4111
Practice Address - Street 1:841 PRUDENTIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8346
Practice Address - Country:US
Practice Address - Phone:904-633-4110
Practice Address - Fax:904-633-4111
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9436249163WP0200X
FLAPRN11010020363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics