Provider Demographics
NPI:1073060893
Name:KACHHWAHA, KECY (ARNP-C)
Entity Type:Individual
Prefix:
First Name:KECY
Middle Name:
Last Name:KACHHWAHA
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:5350 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4562
Practice Address - Country:US
Practice Address - Phone:352-688-8116
Practice Address - Fax:352-686-9477
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9325916363LF0000X
FLAPRN9325916208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018766200Medicaid
FLIS525ZMedicare PIN
FLIS525XMedicare PIN
FLIS525YMedicare PIN