=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669017083
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERYN NICOLE HASSEY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2019
-----------------------------------------------------
Last Update Date | 07/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37852 MEDICAL ARTS CT # A
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33541-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-788-0439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27296 BONTERRA LOOP APT 414
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-482-4644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9112905
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------