Healthcare Provider Details

I. General information

NPI: 1295914547
Provider Name (Legal Business Name): KATHLYNN ATWATER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S PARSONS AVE
BRANDON FL
33511-6063
US

IV. Provider business mailing address

PO BOX 25437
TAMPA FL
33622-5437
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-4553
  • Fax: 813-681-1191
Mailing address:
  • Phone: 813-854-2003
  • Fax: 813-855-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP2531632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: