Basic Information
| Provider Information | |||||||||
| NPI: | 1316675614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELARAKOS | ||||||||
| FirstName: | LOULA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2510 EAGLES CREST CT | ||||||||
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| City: | HOLIDAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346917833 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3231 MCMULLEN BOOTH RD | ||||||||
| Address2: | |||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346956607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277256111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2022 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | 32698243 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.