Provider Demographics
NPI:1821763541
Name:PIATKOWSKI, KAYLA (PA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:PIATKOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S MORGAN ST UNIT 2425
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5360
Mailing Address - Country:US
Mailing Address - Phone:908-721-2190
Mailing Address - Fax:
Practice Address - Street 1:124 S MORGAN ST UNIT 2425
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5360
Practice Address - Country:US
Practice Address - Phone:908-721-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant