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Individual

KATRINA D. BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
3345 S DALE MABRY HWY, TAMPA, FL 33629-7817
(813) 234-0100
Mailing address
10800 BRIGHTON BAY BLVD NE APT 3104, SAINT PETERSBURG, FL 33716-3490
(912) 292-7116

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
004612
GA
363AM0700X
Medical Physician Assistant
Primary
PA9110311
FL

Other

Enumeration date
03/14/2011
Last updated
08/06/2021
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