Healthcare Provider Details

I. General information

NPI: 1205804648
Provider Name (Legal Business Name): KATHRYN D HURVITZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN DOUGHERTY PA

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CATTLEMEN RD SUITE 210
SARASOTA FL
34232-6056
US

IV. Provider business mailing address

3333 CATTLEMEN RD SUITE 210
SARASOTA FL
34232-6056
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-3337
  • Fax: 941-379-3011
Mailing address:
  • Phone: 941-371-3337
  • Fax: 941-379-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA101560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: