Provider Demographics
NPI:1811450240
Name:KOUTSOTHANASIS, ANA CAROLINA (MD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:CAROLINA
Last Name:KOUTSOTHANASIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANA CAROLINA
Other - Middle Name:DE BARROS
Other - Last Name:BARBOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8960 DORCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5911
Mailing Address - Country:US
Mailing Address - Phone:239-600-0440
Mailing Address - Fax:
Practice Address - Street 1:201 14TH ST SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3199
Practice Address - Country:US
Practice Address - Phone:727-588-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME156572207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program