Provider Demographics
NPI:1508834771
Name:VANDOLAH, KATHRYN ROGERS (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROGERS
Last Name:VANDOLAH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:ANDOLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 3978
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-3978
Mailing Address - Country:US
Mailing Address - Phone:770-237-1561
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:7300 BRYAN DAIRY RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1534
Practice Address - Country:US
Practice Address - Phone:727-451-6780
Practice Address - Fax:770-237-1124
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2122282367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN2122282OtherRN LICENSE #