MEDICARE: KYLE BLAKE OWEN 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	APRN11012898	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	:	1578237186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE BLAKE OWEN APRN

Provider Business Mailing Address
First Line	:	34095 SORREL MINT DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7305
Country	:	US
Telephone Number	:	813-395-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 S HABANA AVE
Second Line	:	SUITE 160
City	:	TAMPA
State	:	FL
Zip	:	33609-5429
Country	:	US
Telephone Number	:	813-708-8346
Fax Number	:	866-270-9831

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

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	09/26/2023

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Directions to “ KYLE BLAKE OWEN APRN” Practice Location

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