Healthcare Provider Details

I. General information

NPI: 1306310966
Provider Name (Legal Business Name): KATHRYN E WOLFF ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 LAKE UNDERHILL RD STE 106
ORLANDO FL
32828-4509
US

IV. Provider business mailing address

2822 LANDO LN
ORLANDO FL
32806-7451
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-3325
  • Fax:
Mailing address:
  • Phone: 321-947-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11000575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: