Provider Demographics
NPI:1083608020
Name:KATSARES, KIESHA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:KIESHA
Middle Name:MARIE
Last Name:KATSARES
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:KIESHA
Other - Middle Name:MARIE
Other - Last Name:RABURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:7901 4TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4399
Mailing Address - Country:US
Mailing Address - Phone:813-669-2553
Mailing Address - Fax:813-608-3964
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:813-669-2553
Practice Address - Fax:813-608-3964
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3088792163W00000X
OH12902163WH0200X, 363LA2200X
FLARNP3088792363LA2200X
CANP95019436363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307402100Medicaid
FLY081KOtherBCBS
FLY081KOtherBCBS