Provider Demographics
NPI:1124392774
Name:STRADER, KATHLEEN MARIE COLDWELL (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE COLDWELL
Last Name:STRADER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:COLDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3006 JOSIE BILLIE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2918
Mailing Address - Country:US
Mailing Address - Phone:954-962-2009
Mailing Address - Fax:
Practice Address - Street 1:8150 ROYAL PALM BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5704
Practice Address - Country:US
Practice Address - Phone:954-753-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9248900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily