Healthcare Provider Details

I. General information

NPI: 1558296277
Provider Name (Legal Business Name): KATE M VACCARO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 US 19 N
CLEARWATER FL
33764-7451
US

IV. Provider business mailing address

5517 46TH AVE N
KENNETH CITY FL
33709-3601
US

V. Phone/Fax

Practice location:
  • Phone: 727-541-2646
  • Fax:
Mailing address:
  • Phone: 727-434-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11046085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: