1578694832 NPI number — KAREN WISBY ARNP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578694832 NPI number — KAREN WISBY ARNP

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WISBY

Provider First Name:

KAREN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

ARNP

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

ADKINS

Provider Other First Name:

KAREN

Provider Other Middle Name:

KAYE

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1578694832

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/21/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

14690 SPRING HILL DR STE 101

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SPRING HILL

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

34609-8102

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

352-799-0046

Provider Business Mailing Address Fax Number:

352-606-2857

Provider First Line Business Practice Location Address:

5798 38TH AVENUE NORTH

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ST. PETERSBURG

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33710

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

727-384-0192

Provider Business Practice Location Address Fax Number:

727-384-1500

Provider Enumeration Date:

03/08/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363LF0000X , with the licence number:  ARNP1457132 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 308214800 . This is a "MEDIPASS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 15606901 . This is a "CITRUS-49TH STREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 15606902 . This is a "CITRUS-PASADENA AVE S" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P00441591 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1063472 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 308214800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: Y116T . This is a "BLUE CROSS BLUE SHIELD OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 15606903 . This is a "CITRUS-WEST BAY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P06060 . This is a "FREEDOM HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 3082148 . This is a "MEDIPASS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 308246 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".