Provider Demographics
NPI:1396719357
Name:DOOLING, KATHRYN ANN (NP-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:DOOLING
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 NE 68TH ST
Mailing Address - Street 2:UNIT 204
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1163
Mailing Address - Country:US
Mailing Address - Phone:954-533-4989
Mailing Address - Fax:
Practice Address - Street 1:2121 NE 68TH ST
Practice Address - Street 2:UNIT 204
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1163
Practice Address - Country:US
Practice Address - Phone:954-533-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355506163W00000X
CA15681363LP2300X
FL9295578363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15681OtherFURNISHING NUMBER