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Provider Information for 1346895000

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1346895000

Calendar   Last Updated:  2019-08-08
  Certification Date: 


Name Value
NPI 1346895000
Enumeration Date 2019-08-08
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 127 23RD AVE S
ST PETERSBURG, FL 33705-3209
United States

Phone: 727-639-1965 | Fax:
View Map External Link
Primary Practice Address 1839 CENTRAL AVE
ST PETERSBURG, FL 33713-8900
United States

Phone: 727-322-1054 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LG0600X - Nurse Practitioner Gerontology FL 11003558