Provider Demographics
NPI:1578800355
Name:LEVEEN, KATHRYN M (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:LEVEEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:S
Other - Last Name:GEISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 13833
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:SUITE D2-43
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-2817
Practice Address - Country:US
Practice Address - Phone:352-265-0754
Practice Address - Fax:352-265-0154
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9247824363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9247824OtherFLORIDA LICENSE
FLARNP 9247824OtherFLORIDA LICENSE