Provider Demographics
NPI:1811792518
Name:KNAPPENBERGER, MCKENNA (NP)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:KNAPPENBERGER
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 12TH AVE NE APT 12
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1334
Mailing Address - Country:US
Mailing Address - Phone:610-509-8833
Mailing Address - Fax:
Practice Address - Street 1:615 CHANNELSIDE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5406
Practice Address - Country:US
Practice Address - Phone:610-509-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner