Provider Demographics
NPI:1174801708
Name:TULIPANO, KATIE JO (DMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:TULIPANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CARILLON PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1290
Mailing Address - Country:US
Mailing Address - Phone:727-229-0728
Mailing Address - Fax:
Practice Address - Street 1:2107 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-4153
Practice Address - Fax:941-794-6359
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist