Provider Demographics
NPI:1245407717
Name:THEOBALD, KAREN (ARNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:THEOBALD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:DEPT 6580070407
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-4753
Mailing Address - Fax:727-767-2832
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:DEPT 6580070407
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-4753
Practice Address - Fax:727-767-2832
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1959722363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care