Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11002894 | FL |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 11002894 | FL |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 11002894 | FL |
N | 363LP2300X | Nurse Practitioner - Primary Care | APRN11002894 | FL |
NPI | 1053963702 |
---|---|
Provider Name | Ms. Kathryn Hale |
First Address | Clearwater, FL 33759-3012 |
Second Address | Tampa, FL 33607-6396 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104536100 | (05) | FL |