Provider Demographics
NPI:1710909932
Name:O'BRIEN, KARIN A (APRN)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:A
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 COUNTY ROAD 466
Mailing Address - Street 2:SUITE 101-C
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-4205
Mailing Address - Country:US
Mailing Address - Phone:352-530-2256
Mailing Address - Fax:
Practice Address - Street 1:809 COUNTY ROAD 466
Practice Address - Street 2:SUITE 101-C
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4205
Practice Address - Country:US
Practice Address - Phone:352-530-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172893174400000X
FLAPRN11015647363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1897993Medicaid
MA1897993Medicaid
MANS0344Medicare ID - Type Unspecified