MEDICARE: CATHLEEN M. KELLEY-WEIDEMANN A.R.N.P.

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	363LF0000X	Family Nurse Practitioner	ARNP9233592	FL

General Provider Information

NPI Number	:	1669535175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHLEEN M. KELLEY-WEIDEMANN A.R.N.P.

Provider Business Mailing Address
First Line	:	10334 N CITRUS SPRINGS BLVD
Second Line	:
City	:	CITRUS SPRINGS
State	:	FL
Zip	:	34434-3217
Country	:	US
Telephone Number	:	352-527-0707
Fax Number	:	352-489-7512

Provider Business Practice Location Address
First Line	:	10334 N CITRUS SPRINGS BLVD
Second Line	:
City	:	CITRUS SPRINGS
State	:	FL
Zip	:	34434-3217
Country	:	US
Telephone Number	:	352-527-0707
Fax Number	:	352-489-7512

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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