Provider Demographics
NPI:1730344854
Name:SZCZEPANIK, KATHRYN L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:L
Last Name:SZCZEPANIK
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 1:4611 US HIGHWAY 17 STE 1
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8248
Mailing Address - Country:US
Mailing Address - Phone:904-264-4333
Mailing Address - Fax:
Practice Address - Street 1:4611 US HIGHWAY 17 STE 1
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8248
Practice Address - Country:US
Practice Address - Phone:904-264-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9219129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730344854Medicaid