Basic Information
| Provider Information | |||||||||
| NPI: | 1023349677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROWE | ||||||||
| FirstName: | KIRSTEN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 E. DIXIE AVENUE | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523234267 | ||||||||
| FaxNumber: | 3523235039 | ||||||||
| Practice Location | |||||||||
| Address1: | 5554 CLARCONA OCOEE RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328104056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072920292 | ||||||||
| FaxNumber: | 4072925175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2010 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP 3178682 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 003825400 | 05 | FL | MEDICAID |