Provider Demographics
NPI:1467816728
Name:KWEDER, KARA B
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:B
Last Name:KWEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:7051 DR PHILLIPS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5140
Mailing Address - Country:US
Mailing Address - Phone:407-345-9929
Mailing Address - Fax:407-345-9929
Practice Address - Street 1:7051 DR PHILLIPS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5140
Practice Address - Country:US
Practice Address - Phone:407-345-9929
Practice Address - Fax:407-447-8969
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9335254363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017381200Medicaid