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Individual

KATHLEEN CULLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
21202 OLEAN BLVD, C1, PORT CHARLOTTE, FL 33952-6751
(941) 391-5495
(941) 875-9875
Mailing address
21202 OLEAN BLVD, C1, PORT CHARLOTTE, FL 33952-6751
(941) 391-5495
(941) 875-9875

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA0002743
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
E1089S
MEDICARE PTAN
FL
01
E1089T
MEDICARE PTAN
FL
Enumeration date
08/13/2006
Last updated
05/19/2016
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