MEDICARE: KENNA CAROL PRINS AGPCNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	APRN11030913	FL
2	363LG0600X	Gerontology Nurse Practitioner	APRN11030913	FL
3	363LP2300X	Primary Care Nurse Practitioner	APRN11030913	FL

General Provider Information

NPI Number	:	1699537233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNA CAROL PRINS AGPCNP-BC

Provider Business Mailing Address
First Line	:	10475 GANDY BLVD N UNIT 3308
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-2426
Country	:	US
Telephone Number	:	352-443-9087
Fax Number	:

Provider Business Practice Location Address
First Line	:	10475 GANDY BLVD N UNIT 3308
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-2426
Country	:	US
Telephone Number	:	352-443-9087
Fax Number	:

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

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/30/2024

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