Healthcare Provider Details

I. General information

NPI: 1003806993
Provider Name (Legal Business Name): KATHRYN JEAN WARREN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SW ARCHER RD
GAINESVILLE FL
32608-1136
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0725
  • Fax: 352-265-8432
Mailing address:
  • Phone: 352-273-7832
  • Fax: 352-392-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1455198
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9105043
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: