Provider Demographics
NPI:1063239879
Name:MAZZELLA, KATHRYN LEE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:MAZZELLA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12316 THRASHER AVE
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-0669
Mailing Address - Country:US
Mailing Address - Phone:727-808-3032
Mailing Address - Fax:
Practice Address - Street 1:12316 THRASHER AVE
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34614-0669
Practice Address - Country:US
Practice Address - Phone:727-808-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034602363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health