Provider Demographics
NPI:1629792742
Name:KATTASSERI VARGHESE, NEETHU (ARNP)
Entity Type:Individual
Prefix:
First Name:NEETHU
Middle Name:
Last Name:KATTASSERI VARGHESE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 FANNING BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32409-1741
Mailing Address - Country:US
Mailing Address - Phone:757-602-6433
Mailing Address - Fax:
Practice Address - Street 1:501 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4010
Practice Address - Country:US
Practice Address - Phone:850-913-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty