Healthcare Provider Details

I. General information

NPI: 1942545652
Provider Name (Legal Business Name): CATHY ANN NEWELL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 SUNSET POINT RD
CLEARWATER FL
33765-1132
US

IV. Provider business mailing address

1980 SUNSET POINT ROAD
CLEARWATER FL
33765
US

V. Phone/Fax

Practice location:
  • Phone: 727-443-1588
  • Fax:
Mailing address:
  • Phone: 727-443-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTA8031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: