Healthcare Provider Details

I. General information

NPI: 1144319450
Provider Name (Legal Business Name): KATHERINE EILEEN LIGHT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CLEARWATER LARGO RD N SUITE 2
LARGO FL
33770-2388
US

IV. Provider business mailing address

150 CLEARWATER LARGO RD N SUITE 2
LARGO FL
33770-2388
US

V. Phone/Fax

Practice location:
  • Phone: 727-518-0822
  • Fax: 727-518-6511
Mailing address:
  • Phone: 727-518-0822
  • Fax: 727-518-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP579222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: