Provider Demographics
NPI:1700399433
Name:KAVOUKLIS, EDITH LORRAINE (RN, APRN)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:LORRAINE
Last Name:KAVOUKLIS
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:KEATING-KAVOUKLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4010 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1264
Mailing Address - Country:US
Mailing Address - Phone:813-758-0305
Mailing Address - Fax:
Practice Address - Street 1:4010 W STATE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1264
Practice Address - Country:US
Practice Address - Phone:813-758-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9465920163W00000X
FLAPRN11026304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse