Provider Demographics
NPI:1306310966
Name:WOLFF, KATHRYN E (ARNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:WOLFF
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 LANDO LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-7451
Mailing Address - Country:US
Mailing Address - Phone:321-947-3510
Mailing Address - Fax:
Practice Address - Street 1:12301 LAKE UNDERHILL RD STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4509
Practice Address - Country:US
Practice Address - Phone:407-774-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily