Provider Demographics
NPI:1417286436
Name:SOLOSKY, KELLEY ANN (CRNP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANN
Last Name:SOLOSKY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:ANN
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:565 STATELY SHOALS TRL
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5049
Mailing Address - Country:US
Mailing Address - Phone:302-893-5031
Mailing Address - Fax:
Practice Address - Street 1:9889 GATE PKWY N STE 303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9230
Practice Address - Country:US
Practice Address - Phone:904-300-2809
Practice Address - Fax:888-496-8341
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN542909163W00000X
PASP010687363L00000X
FL11011318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner