MEDICARE: KATHLEEN MAUREEN OGLESBY APRN

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	363L00000X	Nurse Practitioner	APRN11018616	FL

General Provider Information

NPI Number	:	1508591017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MAUREEN OGLESBY APRN

Provider Business Mailing Address
First Line	:	5880 49TH ST N STE 104
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2142
Country	:	US
Telephone Number	:	727-528-6100
Fax Number	:	727-528-7895

Provider Business Practice Location Address
First Line	:	5880 49TH ST N STE 104
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2142
Country	:	US
Telephone Number	:	727-528-6100
Fax Number	:	727-528-7895

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

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	07/19/2022

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