Basic Information
| Provider Information | |||||||||
| NPI: | 1376646729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLCYN | ||||||||
| FirstName: | KARENA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5873 S MIAMI RD | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414964362 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5401 SAWYER RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419253427 | ||||||||
| FaxNumber: | 9419258469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363L00000X | ARNP2575242 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P000276203 | 01 | FL | RR MEDICARE | OTHER |