Provider Demographics
NPI:1255815460
Name:CARRUTHERS, KATHRYN MARCINO (MSN, FNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARCINO
Last Name:CARRUTHERS
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MARCINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5328 NEIL DR
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2405
Mailing Address - Country:US
Mailing Address - Phone:423-596-6605
Mailing Address - Fax:
Practice Address - Street 1:5328 NEIL DR
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2405
Practice Address - Country:US
Practice Address - Phone:423-596-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10754363LF0000X
FL9386693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily