Provider Demographics
NPI:1932213774
Name:PANTUSO, KATHY (RNFA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:PANTUSO
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862233
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2233
Mailing Address - Country:US
Mailing Address - Phone:954-275-5575
Mailing Address - Fax:954-602-2813
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 495
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-985-5846
Practice Address - Fax:954-985-2451
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1160572163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology