Basic Information
| Provider Information | |||||||||
| NPI: | 1720033061 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HYNES | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619675033 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619675033 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NN068931 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | APRN11016957 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.