Provider Demographics
NPI:1346567674
Name:RUDOLPH, KAREN (ARNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HARBOR BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5317
Mailing Address - Country:US
Mailing Address - Phone:941-613-3773
Mailing Address - Fax:941-629-6770
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:941-613-3773
Practice Address - Fax:941-629-6770
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1756082363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health