Healthcare Provider Details

I. General information

NPI: 1255317699
Provider Name (Legal Business Name): MS. KAREN DOROTHY KUDIA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE 32ND AVE
OCALA FL
34471-5532
US

IV. Provider business mailing address

1801 SE 32ND AVE
OCALA FL
34471-5532
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-0137
  • Fax: 352-694-3877
Mailing address:
  • Phone: 352-629-0137
  • Fax: 352-694-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN1404942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: