Provider Demographics
NPI:1104986892
Name:VILLANO, KATHRYN SLOTT (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SLOTT
Last Name:VILLANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:STANLEY
Other - Last Name:SLOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1500 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2815
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-527-5510
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE #1800
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-398-7684
Practice Address - Fax:904-398-4998
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95466207VM0101X
TXM4688207VM0101X
FL95466207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001479500Medicaid