Individual
KATRINA POTITHAVORANANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
620 10TH ST N STE 1E, SAINT PETERSBURG, FL 33705-1407
(727) 824-3120
Mailing address
620 10TH ST N STE 1E, SAINT PETERSBURG, FL 33705-1407
(727) 824-3120
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9112237
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104661300
—
FL
Enumeration date
03/09/2016
Last updated
08/17/2023
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