Provider Demographics
NPI:1114929445
Name:AMBLER, KATHLEEN ELLEN (CNM, MSN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ELLEN
Last Name:AMBLER
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:1600 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4204
Practice Address - Country:US
Practice Address - Phone:727-323-3838
Practice Address - Fax:727-456-0751
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9301360363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHX940ZMedicare PIN
WVQ44769CMedicare PIN
2030683Medicare PIN
WVQ44769AMedicare PIN
2030681Medicare PIN
2030682Medicare PIN
WVS07246Medicare UPIN
2030686Medicare PIN
WV7114466OtherAETNA
WV001721080OtherMS BCBS
2030687Medicare PIN
WVQ40872AMedicare PIN
WV3810000458Medicaid
WV2030688Medicare PIN
2030684Medicare PIN
WVQ44769BMedicare PIN