Provider Demographics
NPI:1295326387
Name:KIRKLAND, ANTONIO SR
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:KIRKLAND
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 MATHEWS MANOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4410
Mailing Address - Country:US
Mailing Address - Phone:904-472-3784
Mailing Address - Fax:904-354-1180
Practice Address - Street 1:1951 MATHEWS MANOR DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-4410
Practice Address - Country:US
Practice Address - Phone:904-472-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician