Basic Information
Provider Information
NPI: 1619310109
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBBINS
FirstName: KATLYN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MATTE
OtherFirstName: KATLYN
OtherMiddleName: B
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: CRNA
OtherLastNameType: 1
Mailing Information
Address1: 809 S ALBANY AVE
Address2:  
City: TAMPA
State: FL
PostalCode: 336062407
CountryCode: US
TelephoneNumber: 8138444434
FaxNumber: 8138444972
Practice Location
Address1: 1 TAMPA GENERAL CIR
Address2: SUITE A327
City: TAMPA
State: FL
PostalCode: 336063571
CountryCode: US
TelephoneNumber: 8138444434
FaxNumber: 8138444972
Other Information
ProviderEnumerationDate: 04/15/2013
LastUpdateDate: 04/08/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP 9305865FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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