Healthcare Provider Details

I. General information

NPI: 1023733474
Provider Name (Legal Business Name): KATLYN MAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/07/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 APPLEGATE DR
SPRING HILL FL
34606
US

IV. Provider business mailing address

4210 COMMERCIAL WAY # 1025
SPRING HILL FL
34606-2325
US

V. Phone/Fax

Practice location:
  • Phone: 352-405-5740
  • Fax:
Mailing address:
  • Phone: 352-405-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMT4177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: