Provider Demographics
NPI:1821035973
Name:TOOTLE, KAREN P (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:P
Last Name:TOOTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 SOUTHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6543
Mailing Address - Country:US
Mailing Address - Phone:727-408-5079
Mailing Address - Fax:
Practice Address - Street 1:5504 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-1900
Practice Address - Country:US
Practice Address - Phone:813-948-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050961207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821035973Medicaid
VA3810017461Medicaid
TN1522382Medicaid
VA7100128730Medicaid
TNTN0123OtherJOHN DEERE
TN1522382Medicaid
VAVAA100616Medicare PIN
VA3810017461Medicaid
013876A49Medicare PIN