Provider Demographics
NPI:1174171813
Name:WOLD, DOROTHY LYNNE HARRISON (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LYNNE HARRISON
Last Name:WOLD
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17222 HOSPITAL BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8906
Mailing Address - Country:US
Mailing Address - Phone:352-678-5550
Mailing Address - Fax:352-678-5551
Practice Address - Street 1:5100 W KENNEDY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1817
Practice Address - Country:US
Practice Address - Phone:813-935-4145
Practice Address - Fax:813-935-0550
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003770363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104317300Medicaid
FLPC675OtherMEDICARE