Provider Demographics
NPI:1801910237
Name:KATZ, ALISA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1026
Mailing Address - Country:US
Mailing Address - Phone:718-938-2520
Mailing Address - Fax:
Practice Address - Street 1:3655 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-6307
Practice Address - Country:US
Practice Address - Phone:813-854-7239
Practice Address - Fax:813-854-7005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9373538163WX0106X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WX0106XNursing Service ProvidersRegistered NurseOccupational HealthGroup - Single Specialty