Female

Katrina Potithavoranant

Medical Physician Assistant in Saint Petersburg, FL(View on Map)

Full Name

Katrina Potithavoranant

NPI Number

1710348479

NPI Type

Individual Provider

Gender

Female

Enumeration Date

03/09/2016

Specialties

(Taxonomies)

Code

363AM0700X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

PA9112237

Contact
Information

Purpose

Mailing
Location

Address

620 10TH ST N STE 1E
620 10TH ST N STE 1E

City

Saint Petersburg
Saint Petersburg

State

FL
FL

Postal Code

33705-1407
33705-1407

Country

US
US

Telephone Number

(727) 824-3120
(727) 824-3120

Identifiers

Identifier

104661300

Identifier State

FL

Identifier Issuer

Unknown

Health Information Exchange

Endpoint Type

DIRECT

Endpoint

Katrina.PotithavoranantPA@direct.mybaycare.org

Endpoint Description

Unknown

Use

Health Information Exchange (HIE)

Content Type

CSV

Affiliation

Y

Endpoint Location

BayCare Medical Group, Inc.2995 Drew St Fl 2Clearwater, FL337593012US

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/17/2023

Provider Address

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