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NPI Code Detail

MEDICARE: MRS. KATELYN SUZANNE MAZUCH CNM

MEDICARE: MRS. KATELYN SUZANNE MAZUCH CNM
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
1363LW0102XWomen's Health Nurse PractitionerAPRN11014793FL
2367A00000XAdvanced Practice MidwifeAPRN11014793FL

General Provider Information

NPI Number : 1770006108
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATELYN SUZANNE MAZUCH CNM
Provider Business Mailing Address
First Line : PO BOX 748817
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8817
Country : US
Telephone Number : 813-286-0033
Fax Number : 813-282-1806
Provider Business Practice Location Address
First Line : 4030 W BOY SCOUT BLVD STE 800
Second Line :
City : TAMPA
State : FL
Zip : 33607-5713
Country : US
Telephone Number : 813-286-0033
Fax Number : 813-282-1806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2017
Last Update Date : 01/06/2026

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