Healthcare Provider Details

I. General information

NPI: 1982662011
Provider Name (Legal Business Name): KATHLEEN A. PALYO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34771-5806
US

IV. Provider business mailing address

1700 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34771-5806
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-2965
  • Fax: 407-891-2966
Mailing address:
  • Phone: 407-891-2965
  • Fax: 407-891-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000834A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: