Healthcare Provider Details

I. General information

NPI: 1083608020
Provider Name (Legal Business Name): KIESHA MARIE KATSARES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIESHA MARIE RABURN ARNP

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 813-669-2553
  • Fax: 813-608-3964
Mailing address:
  • Phone: 813-669-2553
  • Fax: 813-608-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberARNP 3088792
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number12902
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP3088792
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12902
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95019436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: