Provider Demographics
NPI:1891232823
Name:LATAILLE, KATHRYN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:LATAILLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:TIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34866 US HIGHWAY 19 N # 27
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1918
Mailing Address - Country:US
Mailing Address - Phone:727-463-7266
Mailing Address - Fax:
Practice Address - Street 1:34866 US HIGHWAY 19 N # 27
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1918
Practice Address - Country:US
Practice Address - Phone:727-463-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9285856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily