Provider Demographics
NPI:1821097460
Name:DAILEY, KATHLEEN M (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:DAILEY
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SOUTH FEDERAL HIGHWAY
Mailing Address - Street 2:CVS MINUTECLINIC
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-218-0908
Mailing Address - Fax:401-652-1125
Practice Address - Street 1:1700 SOUTH FEDERAL HIGHWAY
Practice Address - Street 2:CVS MINUTECLINIC
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-218-0908
Practice Address - Fax:401-652-1125
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2853532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7564ZMedicare ID - Type Unspecified
FLP61495Medicare UPIN