Provider Demographics
NPI:1366219222
Name:MOYNIHAN, KATHRYN (PMHNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 LAKE HELEN OSTEEN RD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-1068
Mailing Address - Country:US
Mailing Address - Phone:407-461-4099
Mailing Address - Fax:
Practice Address - Street 1:6511 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4021
Practice Address - Country:US
Practice Address - Phone:813-605-1122
Practice Address - Fax:813-354-2430
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2023154821363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health