Provider Demographics
NPI:1316068901
Name:FOSEN, KATINA MELANIE (MD)
Entity type:Individual
Prefix:DR
First Name:KATINA
Middle Name:MELANIE
Last Name:FOSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6919 N DALE MABRY HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3860
Mailing Address - Country:US
Mailing Address - Phone:813-935-4210
Mailing Address - Fax:813-932-7940
Practice Address - Street 1:1501 S PINELLAS AVE STE J
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1951
Practice Address - Country:US
Practice Address - Phone:727-943-3640
Practice Address - Fax:727-942-9745
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1196222083P0011X, 207P00000X
GA65107207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014189400Medicaid
FLP01524561OtherRR MEDICARE
FLP01524561OtherRR MEDICARE
FLIB340ZMedicare PIN