Provider Demographics
NPI:1669978383
Name:TALATI, KINJAL K (NP)
Entity type:Individual
Prefix:
First Name:KINJAL
Middle Name:K
Last Name:TALATI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 HIDDEN COVE LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2168
Mailing Address - Country:US
Mailing Address - Phone:734-679-4306
Mailing Address - Fax:
Practice Address - Street 1:2725 PARK DR STE 5
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1023
Practice Address - Country:US
Practice Address - Phone:727-733-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001768363L00000X
MI4704294266363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner