MEDICARE: KATHRYN ANN DOOLING NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	355506	CA
2	363LP2300X	Primary Care Nurse Practitioner	15681	CA
3	363LP2300X	Primary Care Nurse Practitioner	9295578	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15681	OTHER	CA	FURNISHING NUMBER

General Provider Information

NPI Number	:	1396719357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ANN DOOLING NP-C

Provider Business Mailing Address
First Line	:	2121 NE 68TH ST
Second Line	:	UNIT 204
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1163
Country	:	US
Telephone Number	:	954-533-4989
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 NE 68TH ST
Second Line	:	UNIT 204
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1163
Country	:	US
Telephone Number	:	954-533-4989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	04/28/2016

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