Provider Demographics
NPI:1891176657
Name:OLLIFF, KATHERINE ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:OLLIFF
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:GOODING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:1361 13TH AVE S STE 190
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-3235
Practice Address - Country:US
Practice Address - Phone:904-247-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9314828363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner