Provider Demographics
NPI:1578237186
Name:OWEN, KYLE BLAKE (APRN)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:BLAKE
Last Name:OWEN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:34095 SORREL MINT DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7305
Mailing Address - Country:US
Mailing Address - Phone:813-395-3987
Mailing Address - Fax:
Practice Address - Street 1:580 S HABANA AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-5429
Practice Address - Country:US
Practice Address - Phone:813-708-8346
Practice Address - Fax:866-270-9831
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012898363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner