Provider Demographics
NPI:1366954612
Name:EALY, CHRISTY KENNEDY (RN)
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:KENNEDY
Last Name:EALY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12235 NW 7TH LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2734
Mailing Address - Country:US
Mailing Address - Phone:352-333-2525
Mailing Address - Fax:888-276-7948
Practice Address - Street 1:1700 NW 80TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-9177
Practice Address - Country:US
Practice Address - Phone:352-333-2525
Practice Address - Fax:352-333-2525
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9423419163W00000X, 163WH0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9423419OtherFLORIDA BOARD OF NURSING