Provider Demographics
NPI:1144319450
Name:LIGHT, KATHERINE EILEEN (ARNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EILEEN
Last Name:LIGHT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CLEARWATER LARGO RD N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2388
Mailing Address - Country:US
Mailing Address - Phone:727-518-0822
Mailing Address - Fax:727-518-6511
Practice Address - Street 1:150 CLEARWATER LARGO RD N
Practice Address - Street 2:SUITE 2
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2388
Practice Address - Country:US
Practice Address - Phone:727-518-0822
Practice Address - Fax:727-518-6511
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP579222363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304724500Medicaid
FL304724500Medicaid
FL574589Medicare UPIN