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NPI Code Detail

MEDICARE: EDITH LORRAINE KAVOUKLIS RN, APRN

MEDICARE: EDITH LORRAINE KAVOUKLIS RN, 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
1163W00000XRegistered NurseRN9465920FL
2363L00000XNurse PractitionerAPRN11026304FL

General Provider Information

NPI Number : 1700399433
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDITH LORRAINE KAVOUKLIS RN, APRN
Provider Business Mailing Address
First Line : 4010 W STATE ST
Second Line :
City : TAMPA
State : FL
Zip : 33609-1264
Country : US
Telephone Number : 813-758-0305
Fax Number :
Provider Business Practice Location Address
First Line : 4010 W STATE ST
Second Line :
City : TAMPA
State : FL
Zip : 33609-1264
Country : US
Telephone Number : 813-758-0305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2017
Last Update Date : 05/30/2023

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