Healthcare Provider Details

I. General information

NPI: 1912489519
Provider Name (Legal Business Name): KATELYN PEWORCHIK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN AMBER SLOAN

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 CENTRAL AVE
ST PETERSBURG FL
33707-6117
US

IV. Provider business mailing address

6734 S COURT DR
TAMPA FL
33611-5400
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-5242
  • Fax: 727-347-2402
Mailing address:
  • Phone: 315-719-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9475372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: