Healthcare Provider Details

I. General information

NPI: 1740817543
Provider Name (Legal Business Name): KAITLIN KARCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SOUTHERN BLVD
LOXAHATCHEE FL
33470-9203
US

IV. Provider business mailing address

13125 TANGERINE BLVD
WEST PALM BEACH FL
33412-1918
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-3300
  • Fax:
Mailing address:
  • Phone: 561-602-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9416748
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11007089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: