Healthcare Provider Details

I. General information

NPI: 1013622760
Provider Name (Legal Business Name): KATELYN TREPANIER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 HEALTH PARK WAY STE 330
LAKEWOOD RANCH FL
34202-5177
US

IV. Provider business mailing address

1449 SEASPRAY LN
DUNEDIN FL
34698-4516
US

V. Phone/Fax

Practice location:
  • Phone: 941-359-8900
  • Fax:
Mailing address:
  • Phone: 727-748-2706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9116880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: