Individual ProviderKathleen Ellen MullenNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address4500 San Pablo Rd S, Jacksonville, FL 32224-1865(904) 953-2000(904) 345-7776PECOS EnrollmentBased on the most recent information from CMS, provider Kathleen Ellen Mullen does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1205827391Provider TypeIndividualFull NameMullen, Kathleen EllenTitleMs.CredentialARNPGenderFemaleEnumeration Date10/29/2005Last Updated11/29/2016Contact InformationPractice LocationPractice Address4500 San Pablo Rd S, Jacksonville, FL 32224-1865Phone(904) 953-2000FaxUnlisted FaxMailing LocationMailing Address3599 University Blvd S, Jacksonville, FL 32216-4252Phone(904) 345-7776Fax(904) 345-7772Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseARNP1985832FloridaProvider IdentifiersIDDescriptionIssuerID306261900DescriptionMedicaidIssuerUnlistedFloridaIDY050TDescriptionOtherIssuerBLUECROSS/BLUESHIELDFloridaIDP00153960DescriptionOtherIssuerRAILROAD MEDICAREFlorida