Healthcare Provider Details

I. General information

NPI: 1073257630
Provider Name (Legal Business Name): KARLIE RYAN POWERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MISTLETOE CT APT C
SAFETY HARBOR FL
34695-4379
US

IV. Provider business mailing address

515 MISTLETOE CT APT C
SAFETY HARBOR FL
34695-4379
US

V. Phone/Fax

Practice location:
  • Phone: 954-621-7063
  • Fax:
Mailing address:
  • Phone: 954-621-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: