Provider Demographics
NPI:1902909203
Name:CANTZ, KAREN LEE (CPHT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:CANTZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10058 SW VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34269-6752
Mailing Address - Country:US
Mailing Address - Phone:941-743-0323
Mailing Address - Fax:941-505-9657
Practice Address - Street 1:27680 BERMONT RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982
Practice Address - Country:US
Practice Address - Phone:941-505-9583
Practice Address - Fax:941-505-9657
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2501--0010-3031-060183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050458Medicare ID - Type Unspecified