Provider Demographics
NPI:1912489519
Name:PEWORCHIK, KATELYN (ARNP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:PEWORCHIK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:AMBER
Other - Last Name:SLOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6734 S COURT DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-5400
Mailing Address - Country:US
Mailing Address - Phone:315-719-8481
Mailing Address - Fax:
Practice Address - Street 1:5454 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-6117
Practice Address - Country:US
Practice Address - Phone:727-347-5242
Practice Address - Fax:727-347-2402
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9475372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily