Healthcare Provider Details

I. General information

NPI: 1669535175
Provider Name (Legal Business Name): CATHLEEN M. KELLEY-WEIDEMANN A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10334 N CITRUS SPRINGS BLVD
CITRUS SPRINGS FL
34434-3217
US

IV. Provider business mailing address

10334 N CITRUS SPRINGS BLVD
CITRUS SPRINGS FL
34434-3217
US

V. Phone/Fax

Practice location:
  • Phone: 352-527-0707
  • Fax: 352-489-7512
Mailing address:
  • Phone: 352-527-0707
  • Fax: 352-489-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9233592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: