Healthcare Provider Details

I. General information

NPI: 1992168355
Provider Name (Legal Business Name): KATRINA GABRIELLE MYLETT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2016
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 21ST AVE W SUITE D
BRADENTON FL
34209-5642
US

IV. Provider business mailing address

PO BOX 25487
SARASOTA FL
34277-2487
US

V. Phone/Fax

Practice location:
  • Phone: 941-313-7142
  • Fax: 941-794-2805
Mailing address:
  • Phone: 941-202-5342
  • Fax: 855-253-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9325515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: