Provider Demographics
NPI:1245347269
Name:LANGER, KATHRYN A (ARNP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:LANGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN COSTELLO
Other - Last Name:LANGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3748 SW 72ND WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2998
Mailing Address - Country:US
Mailing Address - Phone:352-331-5311
Mailing Address - Fax:
Practice Address - Street 1:2708 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1316
Practice Address - Country:US
Practice Address - Phone:352-548-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1518102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290327000Medicaid