=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114549565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARA L TOMLINSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2020
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1270 SW MAIN BLVD
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32025-6684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-752-7900
-----------------------------------------------------
Fax | 386-752-4472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1270 SW MAIN BLVD
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32025-6684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-752-7900
-----------------------------------------------------
Fax | 386-752-4472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN5232416
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | APRN11036816
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------