Provider Demographics
NPI:1205804648
Name:HURVITZ, KATHRYN D (PA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:HURVITZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3333 CATTLEMEN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6056
Mailing Address - Country:US
Mailing Address - Phone:941-371-3337
Mailing Address - Fax:941-379-3011
Practice Address - Street 1:3333 CATTLEMEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6056
Practice Address - Country:US
Practice Address - Phone:941-371-3337
Practice Address - Fax:941-379-3011
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA101560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8661WMedicare PIN
P77266Medicare UPIN