Healthcare Provider Details

I. General information

NPI: 1295142016
Provider Name (Legal Business Name): CATHERINE R PAPATHEODOROU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE R MARIANO

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NOLAND DR
BRANDON FL
33511-5719
US

IV. Provider business mailing address

4308 N HABANA AVE
TAMPA FL
33607-6316
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-8100
  • Fax: 813-874-0099
Mailing address:
  • Phone: 813-490-9495
  • Fax: 813-874-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberARNP9476459
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00510200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9476459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: