Provider Demographics
NPI:1356367379
Name:ACKLEY, KAREN M (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 WILSKY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625
Mailing Address - Country:US
Mailing Address - Phone:813-961-2222
Mailing Address - Fax:813-961-2220
Practice Address - Street 1:10111 WILSKY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-961-2220
Practice Address - Fax:813-961-2222
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 92724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272866400Medicaid
FL272866400Medicaid