Provider Demographics
NPI:1831547025
Name:MINACCI, CATHLEEN (ARNP)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:MINACCI
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 1:5038 ASHINGTON LANDING DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3514
Mailing Address - Country:US
Mailing Address - Phone:813-615-8934
Mailing Address - Fax:
Practice Address - Street 1:7406 FULLERTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3552
Practice Address - Country:US
Practice Address - Phone:904-538-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2994432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner