=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740699198
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARA DODGE ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2014
-----------------------------------------------------
Last Update Date | 02/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3472 FOREST HILL BLVD STE 3B
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-5684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-965-8222
-----------------------------------------------------
Fax | 561-963-0509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7593 W BOYNTON BEACH BLVD STE 220
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-6162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-649-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 9308559
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------