Loralee Koontz, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101349 Issued in FL

Practice address

2605 W. Swann Ave
Suite 300
Tampa, FL 33609-4039

Phone

(813) 872-9551

Fax

(813) 872-9554

NPI assigned

Aug 30, 2006

Last updated

Jul 11, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Tampa Dermatology PL

  dba South Tampa Dermatology

  • Specialist
  • Tampa, FL
  • NPI 1467568477
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341964800000",
    "number": "1750490629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 W. SWANN AVE",
            "address_2": "SUITE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094039",
            "telephone_number": "813-872-9551",
            "fax_number": "813-872-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 W. SWANN AVE",
            "address_2": "SUITE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094039",
            "telephone_number": "813-872-9551",
            "fax_number": "813-872-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "LORALEE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2012-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291750500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kool Kidz Pediatric Dentistry
• Vicki Koonce
• Parichart Koonkitti, M.D.
• Morgan Koons
• David B Koontz, CRNA
• Jeffrey Allen Kooper, MD
• Scott Ellis Kooperman, MD
• Carolyn Michelle Koos
• Steven P Koos, ARNP
• Kalie Marie Kopecek

• Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.