=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699537233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNA CAROL PRINS AGPCNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2024
-----------------------------------------------------
Last Update Date | 04/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5434 W TYSON AVE UNIT 1340
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33611-3687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-351-6000
-----------------------------------------------------
Fax | 828-287-7436
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 SPARKS DR
-----------------------------------------------------
City | FOREST CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28043-9021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-351-6000
-----------------------------------------------------
Fax | 828-287-7436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | APRN11030913
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN11030913
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11030913
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------