Basic Information
| Provider Information | |||||||||
| NPI: | 1861749418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS-TROGNITZ | ||||||||
| FirstName: | ANNIE | ||||||||
| MiddleName: | KATHRYN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 917770 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328910001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3515 E. FLETCHER AVE. | ||||||||
| Address2: | MDC14 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336134706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139748900 | ||||||||
| FaxNumber: | 8139743223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2012 | ||||||||
| LastUpdateDate: | 08/13/2012 | ||||||||
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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 | 1041C0700X | SW10508 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.