Provider Demographics
NPI:1790454700
Name:DOLY, KAREN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:DOLY
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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33846-0185
Mailing Address - Country:US
Mailing Address - Phone:848-456-0269
Mailing Address - Fax:
Practice Address - Street 1:E.COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:863-250-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011841363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner