MEDICARE: MISS KATHRYN JEAN WARREN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	1455198	FL
2	363A00000X	Physician Assistant	PA 9105043	FL
3	363A00000X	Physician Assistant	PA9105043	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003806993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHRYN JEAN WARREN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 918025
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-8025
Country	:	US
Telephone Number	:	352-273-7832
Fax Number	:	352-392-8530

Provider Business Practice Location Address
First Line	:	2000 SW ARCHER RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1136
Country	:	US
Telephone Number	:	352-265-0725
Fax Number	:	352-265-8432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	05/20/2016

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